The method of surgical treatment of perforative ulcer piloroduodenalnoy zone

 

(57) Abstract:

The invention relates to medicine, namely to abdominal surgery. On the perforative hole from serous cover impose two collagen plate with an adhesive coating on the basis of fibrinogen, thrombin and Aprotinin. This second plate is applied over the first, and the top plate is larger bottom. The method can improve the outcomes of surgical treatment of perforated ulcers piloroduodenalnoy zone. 1 Il.

The invention relates to surgery, and in particular to treatment of perforative ulcer piloroduodenalnoy zone.

Known treatment of perforative ulcer piloroduodenalnoy zone closure /A. I., VV gorbashko et al. , "Surgery", 1986 , 11, S. 96-101/, however, this method of treatment, as a rule, is associated with possible complications in the postoperative period in the form of formation of organic pyloric stenosis with forced re-operative treatment.

It is also known that applies biological tamponade perforating holes large gland on Polikarpov, which also leads to numerous complications due to not enough good epithelialization and hardening utashiro of the invention is to improve the outcomes of surgical treatment of perforated ulcers piloroduodenalnoy zone with the elimination of the possibility of stenosis privratnikovogo zone.

This goal is achieved by the fact that the closure of the defect is carried out by serous cover collagen plate with adhesive coating, in particular on the basis of fibrinogen, thrombin and Aprotinin.

With the aim of strengthening and increasing the reliability of operation over pasted on perforating ulcer of the collagen plate placed second layer, larger than the previous one.

In Fig. 1 presents the schematic closure of perforated ulcer piloroduodenalnoy zone two plates of collagen, coated with fibrinogen, thrombin and Aprotinin.

The method is illustrated by the following specific examples of its implementation.

Example 1.

In mongrel dogs weighing 12 kg was established model daily peritonitis by the method of C. M. Buyanova et al. / "Surgery", 1997 , 1, S. 25-28/. After 24 hours, if relaparotomy observed phenomena diffuse fibrinous-purulent peritonitis. Model perforating ulcers piloroduodenalnoy zone created dosed electrocoagulation, which helped to stop the bleeding from the submucosal layer. The diameter of the perforated hole was 1 see Perforative hole 1 (see Fig. 1/ sealed up collagen plate 2, which "Zakhoder the first plate, the second 3 are larger in size.

In the postoperative period, the animal did not conduct any special anti-ulcer treatment, decompressive probe into the stomach did not enter. The dog drank the water in the first day of the postoperative period without restriction. Feeding the animal started with 2 days. The postoperative period was uneventful.

Just operated 12 dogs with good immediate results. The animals were removed from the experiment at different times. 3 dogs lived for 2 months, after which they had obtained morphological material. Complete epithelization was observed in the period of 14-16 days after surgery. Stenosis of the output section of the stomach is not found.

The obtained experimental data allowed us to implement the method in the clinic. Driven clinical observation.

Example 2

Patient K. , 21, was admitted with a clinical picture of perforation of the stomach after 4 hours from the onset of the disease. During laparotomy found ruptured ulcer on the anterior wall of the pyloric. The diameter of the perforating holes of 0.5 cm was marked perifocal infiltration. In the abdominal cavity was observed phenomena diffuse serous-fibrinous peritonitis. After ogena, thrombin and Aprotinin on top of it marked the second plate are larger in size. After checking the tightness of the abdominal cavity sutured, leaving drainage in the subhepatic space and nasogastric tubes for passive aspiration of gastric contents. In the postoperative period the patient received conventional therapy, including antibiotics and inhibitors of gastric secretion. The probe is removed from the stomach by the end of the 2 day, 3 day appointed fractional gentle meals with the gradual expansion of the diet. At 14 days after surgery esophagogastroduodenoscopy performed, which revealed mild edema and hyperemia of the bulb 12 SC intestine, as well as fresh scar on the front wall of privratnikovogo zone without deformation. The patient was discharged from the hospital on the 16th day in a satisfactory condition. When the control endoscopy outpatient conducted after one and a half months after surgery, ulcers, stenosis privratnikovogo zone not found.

The proposed technique of closure of perforated ulcer piloroduodenalnoy zone allograft-based collagen, fibrinogen, thrombin and Aprotinin is not obvious to a person skilled surgeon working in this oblationem or tamponade biological material (great seal) in the presence of a large perforated holes. We first performed the way to rapid closure of the defect allograft from serous cover, and researched and proven reliable closing this defect using a two-layer overlay allograft. This method is especially not intuitive for surgeons-gastroenterology, because the defect is closed in areas of increased motor activity, where, apparently, it's hard to resist the allograft-based adhesion to the serosa. The method requires a long experimental studies, which confirmed its safety and feasibility of application in the clinical setting.

The method is ready for use in the clinic in the presence of allograft - collagen plate with adhesive coating, in particular on the basis of fibrinogen, thrombin and Aprotinin. As such allografts can be used the drug company Nycomed - efficiency.

Plate preparation efficiency should be applied with double-layer burying the upper layer of 1-1,5 cm, which improves the mechanical strength of the coating.

The method can be used by the surgeon of any qualification in surgical wards General the operational ulcers piloroduodenalnoy zone, including the closure of the defect allograft, characterized in that on the perforative hole from serous cover impose two collagen plate with an adhesive coating on the basis of fibrinogen, thrombin and Aprotinin, while the second plate is applied over the first, and the top plate is larger bottom.

 

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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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