SU1717117A1 - Method for treating the chronic disturbances of duodenal patency - Google Patents

Abstract

The purpose of the invention is to improve the evacuation of the duodenum and prevent the occurrence of a vicious circle. Perform laparotomy. The short loop of the small intestine 1 at a distance of 1.2-14 cm from Traycev ligament 2 is placed in the vertical position of the transversely lower horizontal part of the duodenum 3 and is fixed with serous-muscular sutures 4, along the upper contour of the latter. In the middle of the distance between the upper and lower edges of the lower horizontal part of the duodenum, a series of sero-muscular sutures is placed, with the duodenum being grasped in the longitudinal direction and the jejunum in the transverse directions. In parallel, the lines of these seams. Longitudinally open the duodenal and transverse jejunum. A longitudinal-transverse anastomosis 5 is applied with two rows of sutures, while the second row of sutures is placed on the lower lip along the lower contour of the duodenum 6, and the garetitum peritoneum is captured. The leading end of the jejunum 1 is additionally fixed with several sutures through the opening in the mesentery of the transverse colon to the antrum of the stomach 7. In the functional form of the disease, the duodenum is additionally muffled by immersing the front wall of the sternoplasty 8. 1 z.p. f-ly, 1 ill. with C

Description

The invention relates to medicine, namely to surgery, and can be used for surgical treatment of diseases of the stomach and duodenum,

The aim of the invention is to improve the evacuation of contents from the duodenum <and to prevent the occurrence of a vicious circle, which is achieved by the fact that they form a longitudinal 'transverse duodenojejunal anastomosis in the vertical transverse position of the jejunum with fixation of its leading section to the distal stomach, and in patients with functional forms of the disease additionally drown out the distal duodenum.

The method is illustrated in the drawing and is as follows.

Produce a mid-upper laparotomy with a bypass of the navel on the left. After revision of the abdominal organs, a short loop of jejunum 1 at a distance of 1214 cm from the Tracheal ligament 2 is placed in a vertical position transverse to the lower horizontal part of the duodenum 3 and fixed with serous-muscular sutures 4 along the upper contour of the latter. Then, in the middle of the distance between the upper and lower edges of the lower horizontal part of the duodenum, a series of sero-muscular sutures are applied, while the duodenum is seized in the longitudinal, and the skinny in the trusted direction. Then, parallel to the line of these sutures, a longitudinally duodenal and transversely jejunum is opened. A longitudinal-transverse anastomosis 5 is applied with two rows of sutures, while the second row of sutures on the lower lip is applied along the lower contour of the duodenum 6, capturing the perietal peritoneum.

The leading end of the jejunum 1 is additionally fixed with several sutures through the hole in the mesentery of the transverse membrane to the pyloric antrum 7.

In patients with a functional form of the disease (duodenal dyskinesia), a stub is formed in the outlet section in the form of a longitudinal invaginate of the anterior wall by applying 3-4 serous-muscular sutures 8 that overlap the intestinal lumen by immersion 2/5 of the circumference of the anterior wall.

Example. A 16-year-old patient was admitted to the clinic on 08/16/85- with complaints of vomiting after each meal, a feeling of fullness and heaviness in the epigastric region on the right, rumbling in this place, constipation, weakness, dizziness. Sick for more than 7 months. Objectively noted weight loss, slight pain in the epigastrium on the right, rumbling. Conducted ^^ cha radiography of the stomach, probe ^ oakDenography, fibrogastrography, aortotra ^ yya. Diagnosis: chronic violation of duodenal patency, duodenogastric reflux. 08/27/85, the operation under general anesthesia, performed mid-upper laparotomy, revision of the abdominal organs. A precardial vagotomy was performed. Next, a short loop of the jejunum is laid in a vertical position across the lower horizontal part of the duodenum and at a distance of 20 cm from the tracheal ligament between them a longitudinally-transverse duodenoeunoanastomosis is double-stitched. The leading section of the jejunum is hemmed through an opening in the mesentery of the transverse colon to the antrum of the stomach. In the duodenum distal to the anastomosis, a longitudinal plug is formed with four sutures that tighten the upper and lower edges of the anterior wall. Layered seams on the wound, dressing. Observation in subsequent years, the patient's condition is good, no complaints.

The method was applied in 23 patients with good results. Recommended for practical use.

Claims (2)

Claim 1. A method of treating chronic duodenal obstruction, including the application of anastomosis, side to side between the lower horizontal part of the duodenum and the initial section of the jejunum, characterized in that, in order to improve evacuation from the duodenum and prevent the occurrence of a vicious circle, leading the jejunum fixed in a vertical position to the distal stomach and along the inner contour of the lower horizontal part of the duodenum, while the jejunum is dissected pop transerectally, and the duodenum - longitudinally. 2. The method according to claim 1, with the fact that in the functional form of the disease, the anterior wall of the distal duodenum is invaginated with serous-muscular sutures.