Method of sealing a seam of the lesser curvature of the stomach stump on buinov b. b.

 

(57) Abstract:

Usage: in surgery, when the sealing seam of the lesser curvature of the gastric stump. Entity: leading loop of jejunum is fixed around the seam formed gastric stump symmetrically arranged gray-serosal sutures.

The invention relates to medicine, namely to surgery.

The closest is a method of sealing a seam of the lesser curvature of the stomach stump on CABALLERO (peller), which after intussusception in addition to the formed seam of the lesser curvature sew the wall of the afferent loop 3-4 zerozerozero seams with capture both walls of the stomach stump (Shalimov A. A. Surgery of the stomach and duodenum. Kiev, Health, 1972, S. 46). When the contraction joints the tensile force is concentrated on the seam of the lesser curvature of the gastric stump. And when the imposition of additional seams reinforced invagination, which can cause obstruction in the region of the cardia and gastrojejunostomy. In addition, increases the force of gravity, thereby increasing the risk of eruption of the joints of the lesser curvature with the development of peritonitis.

The aim of the proposed method of sealing a seam of the lesser curvature of the stump W the leading loop carry around a bead core symmetrically arranged gray-serosal sutures.

The advantage of the proposed method is reduced in 2 times operating at him tensile load, the other half of which is perceived filed the wall of the afferent loop. This reduces the number invaginating rows of seams and reduce the height of the fin, and thus the possibility of occurrence in the region of the cardia and gastrojejunostomy obstruction.

The proposed method is as follows.

Produce upper median laparotomy, the mobilization of the stomach and duodenum, cutting off the stomach from the duodenum, closure of the stump. Then cut mobilized part of the stomach with a cross section of all the lesser curvature at the stair resections, and the lumen of the stomach stump partially taken from the lesser curvature, and then form the gastrojejunostomy, and skinny intestine to education gastroentero - anastomosis take a length of 30-40 cm from the ligament of Tratta depending on the length of the longest sutured the lesser curvature of the stomach stump and taking into account, in order not to compress the transverse colon. Gastrojejunostomy form a double seam. Over the seam of the lesser curvature impose the wall of the afferent loop, which gray-serous suture the Islands of the lesser curvature, continue further along this side, round end into the region of the cardia, continue on the other side of the seam of the lesser curvature in the direction of the gastrojejunostomy and finish it. Gray-serous suture impose symmetrically with respect to the lesser curvature, and then create an inter-intestinal fistula between the afferent and efferent loops of bowel and the operation complete layer suturing of the abdominal wall.

P R I m m e R. Patient D., aged 57, was admitted to the hospital with complaints of General weakness, weight loss, pain in the stomach, nausea, alternating lameness. The patient underwent clinical examination. The study kislotoproduktsiya functions of the stomach (pH-metry) indicated continuous kislotoobrazovanie medium intensity, normalguy response to histamine.

Fibrogastroduodenoscopy: the esophagus is freely pass. The stomach contains mucus. Peristalsis in the back can not be traced. In the upper part of the body of the stomach has a large defect of mucous membrane with dimensions of 3.0 x 2.0 x 1.5 cm with infiltrated edges. Biopsy of the ulcer edge calloused consistency, its bottom covered with a fibrinous plaque. Inflammatory infiltration pronounced around the ulcer. Conclusion: calles ludka.

The radiological examination of the stomach revealed changes, it is highly suspicious for a malignant process in the soil kallanai ulcers. Diagnosed with ulcers subcatalog Department of the stomach with suspected malignancy, the patient was taken for surgery. Produced upper median laparotomy, during inspection found a large ulcer in subordination Department, with a marked infiltration of the stomach wall. Technical difficulties due to the presence of inflammatory infiltration and the PoWPA - statements seams at the formation of the lesser curvature of the stump is made stair gastric resection with excision of all the lesser curvature. After application of the gastrojejunostomy small curvature due to unreliable close to protect her joints from further eruption and development of peritonitis was strengthened by filing the wall of the afferent loop in the form of "Zap - plate". For this purpose the wall of the afferent loop sewed grey-serous seams in the cult of the stomach, and this seam is started from the seam of the gastrojejunostomy on one side of the seam line of the lesser curvature, continued this side of him, bending around its end in the region of the cardia, and then on the other side of the seam of the lesser curvature in the direction of the gastrojejunostomy and finished it. Gray-CE is ulozhenie inter-intestinal anastomosis between the afferent and efferent loops and layered closure of the abdominal wall. The postoperative period was uneventful.

At discharge, the patient's condition is satisfactory, dyspeptic disorders no. Examined 3 months after discharge from the hospital. Complaints from the gastrointestinal tract is not really gaining weight, appetite good, signs resection disorders are not detected.

Thus, the proposed method provides sealing seam of the lesser curvature of the stomach stump even in the presence of pronounced inflammatory changes its tissues, which is achieved by reducing 2 times tension on the seam of the lesser curvature, and the other half which is perceived filed the wall of the afferent loop. The use of this method allowed only one near invaginating seams that reduced the height of the keel and, therefore, warned the education obstruction in the region of the cardia and gastrojejunostomy.

Method of sealing a seam of the lesser curvature of the stomach stump, including the fixation of the afferent loop of the small intestine to the small curvature is formed in the region of the seam gray-serous seams, characterized in that, to improve the reliability of the stump by reducing the height of the keel, the fixation pet is

 

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FIELD: medicine.

SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.

EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.

5 cl, 1 dwg

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