SU1232227A1 - Method of treatment of duodenal peptic ulcer - Google Patents

Description

The invention relates to medicine, in particular to surgery, and can be used in the treatment of ulcer duodenal ulcer.

The purpose of the invention is to reduce the trauma of the operation by simplifying it and reducing the gastric ligamentous apparatus.

The operation is performed as follows.

Upper median incision open the abdominal cavity. Near the lesser curvature, the first, proximal, intersection of the coronary vein of the stomach, which runs in the transverse direction in the cardial part of the stomach, is crossed. A powerful hemostatic clamp is inserted from the intersection under the food-water-diaphragmatic ligament at an angle of 45 °, forming a wide channel between the ligament and the esophagus wall. Two hemostatic clamps are inserted into the formed channel and between them cross the ligament with the short gastric nerves of the anterior vaginal trunk. Carefully examine the anterior wall of the esophagus, cross the short gastric nerves. At the left edge of the esophagus, an additional vaginal trunk is searched and traversed. Hepatic-gastric ligament (minor omentum) is widely dissected. In the transverse direction, dissect the peritoneum, which covers the anterior pancreatic fold. The tip of a hemostat is held between the posterior vagus trunk and the right edge of the esophagus anteriorly to the posterior surface of the ligament. The tip of the clip on the back surface of the bundle pulls up a thick Teflon thread and leads it to the front surface of the bundle. 1 cm below, a clip is brought through the link again, two threads are being picked up on the back surface - the end of the previous one and the beginning of a new one. The yarns are brought to the front surface of the tie. Such techniques are repeated several times. At the distal edge of the ligament, the thread brought to the front surface is additionally conducted under the anterior vaginal trunk. In the region of the lesser curvature of the stomach, nerve dressing is performed in a similar way. Small gland capture the first, second and third fingers of his left hand. A vascular clamp is held anteriorly to the posterior surface of the organ between the hepato-gastric ligament and the wall of the stomach. The clamp picks up and brings to the front surface a number of threads. After the final overlap, the threads are held. The integrity of the small omentum and the food-diaphragmatic ligament is restored.

The operation was performed in 11 patients with various complications of chronic duodenal ulcer. In all these patients, due to the general condition or the need for other incidences on the abdominal organs, it was necessary

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reducing the time of surgical intervention.

All operations were without complications. Violations of the motor function of the stomach after surgery were noted. Studies of the secretory function of the stomach after surgery showed the achievement of complete vaginal denervation of the acid-excreting zones of the stomach.

Example. Patient K., 55 years old, was admitted to the surgical department of a clinical hospital with complaints of epigastric pain, vomiting, weakness, and weight loss.

Over the course of 5 years, it has suffered from duodenal ulcer disease. Periodically he was treated on an outpatient and inpatient basis. In December 1982, gastro-fibroscopy revealed the dorsal wall of the duodenum, 0.6 x X 1 cm, deformity of the upper part of the duodenum. Two months before admission to the clinic, signs of gastric stenosis were observed.

Fifteen years ago, the patient underwent laparotomy due to a gangrenous perforated appendicitis with subhepatic process of the process. After 7 years, operated on for the alleged perforation of the sigmoid colon.

He underwent two urological operations - left-sided nephrectomy and right-sided nephropexy. Suffer from chronic single kidney pyelonephritis. Treatments for alcoholism.

The general condition of the patient is moderate. Pronounced lack of weight. The chest organs without any changes. On the stomach in both in the lumbar regions there are scars after surgery. In the upper median scar - ventral hernia. Severe tenderness with deep palpation in the epigastrium.

At fluoroscopy of the stomach, signs of subcompensated stenosis of exit from the stomach were revealed.

04/02/83 operations Under endotracheal anesthesia, an upper abdominal incision is opened into the abdominal cavity. Entry into the abdominal cavity is difficult due to extensive soldering with the postoperative scar of the loops of the small and large intestines.

Most of the loops of the small intestine intimately spa to each other, with the loops of the large intestine and the omentum into a large conglomerate. Intra-abdominal adhesions were disconnected. The wall of the small intestine is scarred in many places, the mesentery is shortened, also in cicatricial changes. Taking into account the danger of post-operative adhesions of intestinal obstruction, the patient underwent Noble's intestinoplication.

In the initial part of the duodenum on the front wall there is scar-infiltrative changes, the exit from the stomach is narrowed to a diameter of less than 10 mm.

Taking into account the expansion of the surgical intervention (adhesions disconnection, Noble operation), it was decided to perform denervation of gastric acid-excretion zones with pyloroplasty according to Geinik-Mikulich. According to the described method, the denervation of the acid-excreting zones of the stomach was performed. Proximal coronary vein inflow is crossed. At an angle of 45 ° from the right edge of the esophagus, the diaphragmatic axis and the aqueous link are crossed, and short gastric nerves extending from the anterior vaginal trunk are simultaneously crossed. At the left edge of the esophagus, a search for additional vagal trunks extending to the stomach wall was conducted.

Within the gastro-pancreatic fold between the posterior vaginal trunk and the wall of the esophagus, a series of thick Teflon ligatures was carried out. Similar ligatures are drawn between the wall of the stomach in the area of small curvature and the tissues of the lesser omentum.

slightly below the level of the stomach clippings. After their final imposition, the ligatures are fixed. Integral-esophageal ligament restored. The duration of this stage of the operation did not exceed 10-15 minutes. Piloroplastika on Geynike-Mikulich according to the generally accepted method.

The evacuating function of the stomach after surgery recovered from the third day. From the fourth day the feeding of the patient began.

The described operation is shown in particularly difficult situations (especially in urgent surgery), when, in connection with the accompanying diseases and severity of the patient's condition, it is necessary to carry out the simplest method of denervation of the stomach, which, however, would preserve the motor activity of the antrum. the occurrence of severe evacomotor gastric disorders in the early postoperative period.

Claims (1)

METHOD FOR TREATING ULCER OF THE DUODENAL GID, including denervation. The bottom and the body of the stomach, the intersection of the esophageal-diaphragmatic ligament with the short gastric nerves of the anterior trunk of the vagus nerve, characterized in that, in order to reduce the trauma of the ligament by simplifying the operation and simplifying the operation carried out by neurotripsy, while portioning the esophagus and gastric branches of the posterior trunk with tissue of the gastro-pancreatic fold and hepatic-gastric laying near the body of the stomach. y o o y k) y