UA143606U - METHOD OF SURGICAL TREATMENT OF DUODENAL DAMAGE - Google Patents

Abstract

The method of surgical treatment of duodenal injury includes laparotomy, excision of the edges of the lesion, exclusion of the duodenum from the digestive process, decompression of the duodenum, as well as the introduction of a feeding tube. Exclusion of the duodenum from the digestive process is performed by gastrotomy, the goalkeeper is stitched from the inside with a continuous suture with a non-absorbable thread, and the imposition of a gastroenteroanastomosis. Decompression of the duodenum is performed by imposing a jejunoynoanastomosis "end-to-side". Perform a cholecystostomy. Transnasal is chosen as a feeding tube in the postoperative period.

Description

A useful model belongs to surgery and can be used for surgical treatment of duodenal damage. (DPK), when it is located in departments 03, 04.

A known method is the method of surgical treatment of duodenal damage, which is described in the article by A.I. Sukhodolya, I.V. Chubar "Damage of the duodenum: diagnosis, surgical tactics of treatment" (see Clinical surgery. -2012. - Mo 3.- P. 27). It includes performing a laparotomy, excision of the edges of the damage, exclusion of the duodenum from the digestive process, decompression of the duodenum. Also, the method includes a gastrotomy, suturing from the inside of the stomach gate and the formation of a Roux gastroenteroanastomosis.

The method allows to surgically treat damage to the duodenum, but in the case when it is localized in departments 01, 02, Y3. But the use of the method is fundamentally impossible in the case when it is located in department 04, since the ascending part of the duodenum forms a bend. This anatomical feature increases compression in the intestine, which in turn increases the probability of failure of duodenojejunoanastomosis "end-to-side", which is mandatory in the formation of gastroenteroanastomosis according to Roux.

The closest to a useful model is the method of surgical treatment of duodenal damage according to patent Mo 57618, (OA, application 07/12/2010, published 03/10/2011

The process of diverticulization in duodenal fistulas). It includes performing a laparotomy, excision of the edges of the lesion, exclusion of the duodenum from the digestive process, decompression of the duodenum, and the introduction of a feeding tube.

Excision of the edges of the damage occurs by antrumectomy, that is, removal of the damaged part of the duodenum together with part of the stomach. Before excision of a part of the stomach, trunk vagotomy is performed. Restoring the continuity of the digestive tract is performed by placing an anastomosis between the stump of the stomach and the intestine - Roux's gastroenteroanastomosis and duodenostomy. Transnasal insertion of the probe beyond the anastomosis zone is also performed for feeding the patient in the postoperative period. And decompression of the duodenum is performed by introducing balloon drainage into the duodenostomy.

The method allows for surgical treatment of duodenal damage, but only in the case when the damage is located in the OT or 02 departments, that is, close to the part of the stomach to be resected. But if the damage to the duodenum

Zo is located in the departments of SW or 04, the use of the method is impractical, since it is unacceptable to remove a large volume of the DPK (it is too traumatic and unacceptable for a patient in a serious condition).

Also, during trunk vagotomy, parasympathetic innervation is disrupted, which can lead to the development of post-vagotomy syndrome.

The basis of a useful model is the task of creating a method of surgical treatment of duodenal damage, which is located in the OZ and 04 departments, with a reduction in the risk of suture failure in the postoperative period and at the same time preserving the natural physiological passage of food.

The task is solved by the fact that in the method of surgical treatment of duodenal damage, which includes performing a laparotomy, excision of the edges of the damage, exclusion of the duodenum from the digestion process, decompression of the duodenum, as well as the introduction of a feeding tube, according to a useful model, exclusion of the duodenum from the process digestion is performed by gastrotomy, stitching of the gatekeeper from the inside with a continuous suture with a non-absorbable thread and applying gastroenteroanastomosis, decompression of the duodenum is performed by applying end-to-side jejunojejunoanastomosis, cholecystostomy is performed, and a transnasal feeding tube is chosen in the postoperative period.

The ability of sutures in the postoperative period depends on two mechanical factors, namely: the impact on them of aggressive intestinal contents (food and bile), as well as the level of intra-intestinal pressure.

Reducing the impact of an aggressive environment is ensured by creating a bypass for it, which is formed by installing a probe through which the patient will be fed in the postoperative period. Choosing a transnasal probe when the damage is located in the OZ or 04 departments allows feeding patients in the early postoperative period, since the probe is inserted beyond the anastomotic zone, which excludes the ingress of an aggressive environment (food) and thus reduces the risk of failure of the anastomotic sutures.

Also, early enteral nutrition of the patient allows to shorten the postoperative stay of the patient in the hospital due to the early start of the intestinal tract.

Decompression is provided by the formation of an unloading joint on the selected loop 60 per Ru, which is imposed below the damage: - jejunojejunoanastomosis.

Applying a cholecystostomy allows for the drainage of bile.

The applicant is not aware of examples of choosing different surgical tactics of treatment depending on the localization of duodenal damage.

A detailed description of the useful model is given on examples of its implementation in the clinic. Clinical example 1.

A clinical example.

Patient E., 37 years old, was admitted to the clinic with a diagnosis of "fall from a height, multiple blunt trauma to the abdomen." Diagnostic laparocentesis was performed. Received blood with bile. Urgently operated. It was found intraoperatively: the damage is localized in the B4 section of the duodenum, a rupture of the part of the body of the pancreas of its degree is also visualized. Suturing of part of the damaged pancreas and duodenum with double-row sutures, transnasal intubation for the area of plastic surgery was performed. On the 6th postoperative day, impregnation of the bandages with a bile component is observed. The patient was operated on again. Intraoperatively, a 4x3 cm defect with necrotized edges was found in the area of duodenum pre-suture. Excision of necrotized tissues, suturing with a double-row suture. Gastrotomy, suturing from the inside of the stomach gate and formation of gastroenteroanastomosis according to Ru. An interintestinal joint was applied at a distance of 12 cm from the previously sutured damage. A cholecystostomy was applied. Repeated transnasal intubation for the anastomosis zone was performed. Postoperative period - without special features. The patient was discharged on the 18th postoperative day in a satisfactory condition.

Thus, a method of surgical treatment of duodenal damage has been created, which is located in the departments of OZ, 04, which allows to reduce the risk of suture failure in the postoperative period and does not disturb the natural physiological passage of food.

Claims (1)

UTILITY MODEL FORMULA A method of surgical treatment of duodenal damage, which includes performing a laparotomy, excision of the edges of the damage, exclusion of the duodenum from the digestive process, decompression of the duodenum, and the introduction of a feeding tube, which Zo differs in that the exclusion of the duodenum from the digestive process is performed by gastrotomy, the gatekeeper is stitched from the inside with a continuous suture with a non-absorbable thread, and a gastroenteroanastomosis is applied, the duodenal decompression is performed by applying an "end-to-side" jejunojejunoanastomosis, a cholecystostomy is performed, and how a transnasal feeding tube is chosen in the postoperative period.