SU1673073A1 - Method for executing stomach resection - Google Patents

Abstract

The purpose of the invention is to reduce the incidence of complications due to the reflux of gastric contents into the resulting loop and gastrointestinal reflux. Mobilize and resect the stomach. The stump of the duodenum is sutured. Form the stump of the stomach. The drive loop is hemmed to the back of the stomach. At the same time, in section 1 on the intestinal wall 4 adjacent to the stomach 5, one or two corrugations 6 are formed 6. The width of the intestinal wall capture into the corrugating seams is increased with each subsequent seam to the level of section 2 by increasing the number of corrugations. Thus, the spurs are narrowed and its most narrowed section 8 at the level of section 3 is fastened with a catgut stitch without fixation to the stomach wall, invaginates it into the lumen of the distal section of the intestine 10 by about 2 cm, which is hemmed to the stomach at the level of section 2. Indent about 2 see distal to level 3, dissect the intestine and apply gastroenteroanastomosis. 4 il.

Description

The invention relates to medicine, in particular to surgery, and can be used in the surgical treatment of vzduva stomach disease, duodenal ulcers.

The aim of the invention is to reduce the frequency of post-resection complications caused by the reflux of gastric contents into the afferent loop and gastrointestinal reflux.

According to the proposed method, during the formation of the spur, an anti-reflux valve is created in the driving loop, for which the section of the intestinal wall adjacent to the stomach is corrugated in the longitudinal 15 direction, while the lumen of the intestine, the perimeter of the corrugation from the proximal portion of the spur to the distal, gradually narrow and the constricted area of the spur invaginates into the lumen of the distal section of the intestine, which is fixed to the stomach.

Fig. 1 schematically shows the operation in its final form, rear view; in fig. 2 — spur, cross section along line 1 in FIG. one; in fig. 3 - the same, on the line 25 2; in fig. 4 - the same, on line 3,

The method is carried out as follows.

Mobilize and resect the stomach. The stump of the duodenum is sutured. After the stomach stump is formed, a spur is formed, stitching the intestine to the back wall of the stomach. At the same time, in section 1 on the intestinal wall 4 adjacent to the stomach 5, one or two corrugations 6 are formed. The width 35 of the intestinal wall captures the corrugated seams with each subsequent suture to the level of section 2 by increasing the number of corrugations 7. Thus, the spur is narrowed and its most narrowed 40 section 8 at the level of section 3 is fastened with catgut suture 9 without fixation to the wall of the stomach, invaginates it into the lumen of the lower part of the intestine 10 by about 2 cm, and hemmed to the stomach 45 at the level of section 2. At the same time, the narrowed area of the spur 8, inva inirovanny into the lumen of the underlying portion of the intestine 10 is in the free state and forms the anti-reflux valve. Then, in the 50th part of the intestine distal to section 3 of about 2 cm, a transverse (or longitudinal) dissection of the intestine is performed and gastro-enteroanastomosis is applied.

Example. Patient Sh., 37 years old. Diagnosis: 55-link disease, low penetrating gland. March 16, 1988, the operation was carried out. At revision, a low duodenal ulcer was found with penetration into the head of the pancreas and hepatoduodenal

link, periododuodenitis The cult of the duodenum is sutured by an open method (the bottom of the ulcer is left on the pancreas goyuvka and hepatoduodenal link). Stitched with catgut and immersed in a purse-string and core silk sutures. A 2/3 of the stomach was resected with the formation of a behind-colonic gastrojejunostomy on a short loop. At the same time, when the intestine is stitched to the posterior wall of the stomach (spur formation), it is narrowed from the proximal to the distal part of the spur by corrugating seams to an internal diameter (lumen) of about 1 cm. Then, at a distance of about 1.5 cm from the area sewn to the stomach a corrugated catgut suture is applied without fixation to the stomach, with which the intestinal lumen is narrowed to a diameter of about 0.5 cm, and this area is invaginated in the lower part of the intestine, which is stitched to the stomach. At a distance of about 2 cm from the narrowed section of the intestine, its cross section was made and gastroenteric anastomosis was superimposed. The postoperative period was uneventful. X-ray examination was performed, barium was not thrown into the leading loop, there was no emptying of the stump in portions, no signs of reflux in the stump of the stomach. Discharged on the 14th day in a satisfactory condition.

In all operated patients, post-resection syndromes were absent.

The method prevents the stomach contents from being thrown into the driving loop, as well as gastrointestinal reflux. Recommended for use in clinical practice.

Claims (1)

Invention Formula The method of gastrectomy, including the suturing of the duodenal stump, partial suturing of the gastric stump, the imposition of a behind-the-sided gastroenteroanastomosis end to the side on a short loop and the formation of a spur by stitching a leading loop to the posterior wall of the stomach, which is characterized by the fact that in order to reduce the incidence of complications caused by a cast the gastric contents into the leading loop and with gastrointestinal reflux, form a valve in the leading loop, for which, when creating a spur, a section of the intestinal wall adjacent to the vessel, corrugated in the longitudinal direction, while gradually narrowing the lumen of the intestine from the proximal part of the spur to the distal. after which the constricted area of the spur invaginates into the lumen below the located section of the intestine, which is then fixed to the stomach. FIG. 2 Fm.z 4