UA49716A - Method for sewing stump of duodenum with three-raw suture without pancreatic capsule - Google Patents

Abstract

The method for sewing the stump of the duodenum with three-raw suture without the pancreatic capsule comprises Bilerot’s resection of the stomach (type II) performed from the "end-to-side" gastroenteroanastomosis. The duodenum is sewed with the blanket suture beneath the clamp, the latter being still kept at its position. Then the purse-string suture is performed with the polyester thread. The posterior wall of the duodenum is sutured with three separate stitches in parallel 2-3 cm below the purse-string suture. Upon tightening and tying the first two sutures with three threads sewing the posterior wall, the anterior wall is sewed resulting in the third row of the sutures. In addition, two or three sutures are applied between them.

Description

Description of the invention

The invention relates to medicine, namely to surgery and can be used for the treatment of patients with 2 peptic ulcers of the stomach and duodenum (DPK) and stomach cancer.

There are well-known methods of gastric resection according to Bilyorot - I (B-II), in which the stump of the esophageal sphincter is tightly sutured, and the continuity of the gastrointestinal tract is restored by end-to-side gastroenteroanastomosis.

The disadvantage of these methods is the high risk of developing duodenal stump failure.

The method of Moynigen (Moupinap) (2) is the closest in terms of technical essence and accepted as a prototype. Closure of 70 stumps of DPK. A wrap-around continuous catgut suture is placed on the stump, which is tightened and tied after removing the clamp. The hook is dipped into the purse seam. For the reliability of the DPC stump seam, it is sewn to the capsule of the pancreas.

The disadvantage of the prototype is that the stump under the clamp is sewn with a wrap-around non-disruptive catgut seam, which, after removing the clamp, tightens and ties, which leads to gathering in folds 19 shortening of the stump and the application of the pocket seam becomes more difficult. After applying the pouch suture and immersing the stump in the pouch suture, the deformation significantly increases and the back wall of the intestine is shortened, and peritonization is forcibly performed with suturing of the capsule of the pancreas. If the stump is not securely sutured, such peritonization does not eliminate its failure, which requires long-term treatment for its closure.

The task of the invention is to create a reliable retoning of the pouch seam, at the expense of the back wall of the DPK.

The method is performed in the following order. When indications are established, stomach resection is performed according to B-I.

The DPK below the clamp is stitched with a wrapping catgut seam, and the ends of the threads are taken into the clamp. A pouch suture is applied with Mylar thread at a distance of 1 cm from the cut line along the back wall and 1.5 cm along the front wall, taking into account that when the pouch suture is tightened, the knot is on the operator's side. The back wall of the DPC below the pouch seam by 2 mm is stitched in parallel with three separate sero-muscular stitches of 1 cm length (seam step 5 mm), which are taken in a clamp. The clamp is removed from the stump, the catgut wrapping seam is tightly "tightened, tied, the stump is immersed in the purse seam. The front wall is stitched with the three threads used to sew the back wall and the third row of seams is formed. Additionally, 2 - Z seam is applied between them.

The continuity of the digestive tract is restored by applying end-to-side B-II gastroenteroanastomosis. The postoperative wound is sutured tightly (Fig. 1 - Fig. 4). eh

Example: Patient R., medical chart Mo5328 of an inpatient, was admitted with complaints of pain in the epigastric area, nausea, a feeling of heaviness in the epigastrium after eating, belching, as well as the presence of a tumor protrusion in the area of the navel of considerable size. She has been suffering from umbilical hernia for thirty years, in connection with pregnancy and childbirth. In the last three months, heartburn, bloating, decreased appetite, Ge») decreased body weight appeared. From the anamnesis: she has been suffering from gastric ulcer disease for two years, she has repeatedly undergone courses of conservative therapy for 3 years. WITH

Examined: during fibrogastroduodenoscopy, the esophagus and cardia were not changed. Along the small curvature in the area of the corner of the stomach, the ulcer is up to 3 cm in diameter, deep, the mucous membrane around the ulcer is infiltrated, fibrin covers the bottom of the ulcer. A biopsy was taken. Histological findings: Chronic progressive gastric ulcer. The diagnosis was established: "

Gastric ulcer disease. Omphalocele. After preoperative preparation, an upper-middle Z 50 laparotomy with dissection of the hernia sac was performed. In the distal part of the stomach, along the small curve, there is an ulcer crater to which the mesentery of the colon is soldered. Gallbladder enlarged in size in its lumen, a concretion 5 x Zcm with" occupies the entire lumen. Stomach resection was performed 10 cm above the ulcer crater with a large and small forceps. The stomach is cut off below the pylorus between the clamps. The stump of the DPK below the clamp is sewn with a wrap-around catgut seam. A purse stitch is applied. The back wall of the DPK below the pocket seam 2 - Zmm below is stitched in parallel with three separate mylar stitches that are taken in a clamp. The clamp is removed from the stump, the wrapping catgut seam is carefully tightened and tied. (Te) The hook sinks into the purse stitch. The front wall is stitched with three threads, which are used to stitch the back wall, and a third row of separate knotted seams is formed. In addition, two seromuscular nodular and sutures are placed between them, after which a gastroenteroanastomosis is placed end-to-side. Gallbladder isolated from adhesions, -k 70 cholecystectomy from the neck subserosally. Vessels and bladder duct are ligated separately. Isolated hernial sac from the umbilical ring, cut off. Through a contraperture incision - glove-tube drainage to the bed of the bladder. The postoperative wound is tightly sutured. The lower third of the wound with a hernia repair. The postoperative period was uneventful.

Pathohistological studies Mo19685-9.3" Mo19683-4.3" B/a; Mo19691-2.3". Deep growth of low 29 differentiated adenocarcinoma, sprouting submucosal, muscle, and in some places serous layers with the presence of cancer emboli in vessels;

Cap with a focus of fibrosis, diffuse lymphocytic infiltration and focal hemorrhages; Gallbladder wall with edema, muscle layer sclerosis, diffuse lymphocytic infiltration.

Whole blood of hyalyzed vessels. Concrement bhZsm. The patient was discharged on the 18th day after the operation. At the 60th follow-up examination after 4.5 years, she has no complaints and is practically healthy.

According to the proposed method, 35 patients were operated on, no complications were observed, while during the operation according to the Moynegen method, four of the 56 operated patients developed postoperative pancreatitis, and two had stump failure.

Thus, a comparison with the prototype shows that the use of this method allows reducing the number of postoperative complications.

SOURCES OF INFORMATION: 1. Shalimov A.A., Sayenko V.F.

Surgery of the digestive tract.

K, Zdorovya, 1987. - P.188 - 203. 2. Matyashin I.M., Gluzman A.M.

Directory of surgical operations.

Kyiv, Health, 1979. - P.90.

Claims (1)

The formula of the invention The method of suturing the stump of the duodenum with a three-row suture without the capsule of the pancreas, which / o Includes resection of the stomach according to Billerot - P with gastroenteroanastomosis of the "end-to-side" type, which differs in that the duodenum (DPK) below the clamp is stitched with a wrapping catgut suture , the clip is not removed, a pocket seam is applied with a mylar thread, and the back wall of the DPK below the pocket seam is sewn parallel with three separate stitches, after tightening and tying the first two seams, the front wall is sewn with the three threads used to sew the back wall and form the third row of seams, while adding 2-3 seams between them. « (Se) «- cha (o) « - with . and? sh» se) -I - 50 4) 60 b5