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INVENTION
Russian Federation Patent RU2270617
Method of surgical treatment of complicated ulcers front wall of the duodenum
Name of the inventor: Novomlinets Yuri Pavlovich (RU); Bondarev Gennady A. (RU); Igor Mikhailovich Petukhov (RU); Diachkov Ivan (RU); Surnin Sergey (RU); Svetlana Kozlova
The name of the patentee: Novomlinets Yuri Pavlovich
Address for correspondence: 305041, Kursk, st. Marx, 3, KSMU, patent department, ZN Kupriyanova
Starting date of the patent: 2004.01.26
The invention relates to medicine, surgical gastroenterology, can be used in the treatment of complicated duodenal ulcer. Excised complicated ulcer closed by the front wall of the duodenum. In this case use the clip on workers whose lips are two clamps for fixing the elastic wall is sutured duodenal ulcers. By clamping straps sewn bowel wall continuous U-shaped seam. Cuts fixed in the clamp part of the front wall of the colon ulcer and removed from the clip. Sews the intestinal wall at the site of excision piercing obvivnym seam in the opposite direction. Tie the beginning and end of the ligature. Thus end the imposition of double continuous suture piercing. The method simplifies the excision of ulcers of the front wall of the duodenum, reduce the likelihood of infection of the abdominal cavity.
DESCRIPTION OF THE INVENTION
The invention relates to medicine, namely to the surgical gastroenterology, and can be used in carrying out radical or conventionally radical surgical interventions for complicated duodenal ulcer excision of ulcers by its front wall, or a combination of it with the antacid gastric surgery.
Currently, excision of the anterior wall ulcers duodenum produce fringing cuts its front wall in the longitudinal or transverse direction within the healthy tissue (up to 10 mm from the ulcer) open method (V.I.Onopreev, E.G.Sharapova, AN Pahilina, G.K.Karipidi. surgical Histotopography complicated duodenal ulcers. Proceedings of surgeons conference "Modern problems of emergency and elective surgical treatment of patients with gastric ulcer and duodenal ulcer." Saratov, 2003, 205 pp.).
After excision of the ulcer producing hemostasis in the walls of the intestine and then sutured the defect in the bowel nodal proshivnymi seams with the location of the nodes from the intestinal lumen, or from outside, or sutured intestine precision welds. Some piercing joints peritoniziruyut second row nodal sero-muscular sutures (G.E.Ostroverhov, Yu.M.Bomash, D.N.Lubotsky Operative surgery and topographic anatomy - Kursk: AP "Kursk", Moscow:.. AO ST "Litera ", 1995. - 720 p .; V.I.Onopriev Etudes functional surgery of peptic ulcer Krasnodar 1995 281 c).....
For all methods excision intestine ulcers lumen communicates with the abdominal cavity, it does not exclude ingress content ulcer on her wound and into the abdominal cavity infection with them further steps hemostatic suturing body and require considerable time.
Closure intestine atraumatic suture material to improve the quality of repair for two rows of nodal joints requires the consumption of a significant amount of suture material.
The object of the invention is the excision of the anterior duodenal ulcers wall closed by a special clamping and suturing intestinal bowel wall double continuous suture piercing with piercing peritonization joint second alongside the traditional way when performing laparotomy or minilaparotomy access.
This object is achieved by the fact that after sewing ligature-taped the front wall of the duodenal ulcer with complicated for it to produce the traction and protruding wall transverse colon, departing from the edge of the ulcer by 10 mm, impose intestinal clamp with extra elastic fixation of the bowel wall; suturing the intestine wall in the clamp performed by applying piercing a double seam continuous.
The tool is a clamp on the working jaws which are two elastic braces for rapprochement sutured duodenal wall.
Under staples tool duodenal wall pierced a continuous U-shaped seam atraumatic absorbable suture, cut off the fixed jaw in the front part of the bowel wall with an ulcer and remove the tool. Continuous obvivnym piercing seam, continue to take in the intestinal wall in the opposite direction, then connect the beginning and end of the ligature, then produce peritonization double piercing serous-muscular suture continuous or interrupted sutures.
The invention is illustrated figure (1-4)
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1. Presented fragment protruding anterior wall of the duodenum and ulcers, stitched ligature, overlaid with the clamp with brackets for fixing the elastic intestine.
2. It shows the initial stage of the weld overlay piercing as a continuous U-shaped.
3. Schematically shows a view of the piercing double seam after the imposition obvivnyh stitching and binding beginning and end of the ligature (side view).
4. A schematic view of the front of the bowel wall is sutured to the initial imposition of the second series of nodal sero-muscular sutures (top view).
Method is as follows
After laparotomy or minilaparotomy produce audit and release of adhesions front wall duodenal ulcer, intestinal wall is pierced in sores ligature-taped and her gut produce traction. On the protruding wall laterally intestine, departing from the edge of the ulcer by 10 mm, is applied to clamp the staple elastic fixation of the bowel wall (Figure 1). By stapling instrument duodenum wall pierced continuous U-shaped seam vikrilom (2) is cut off in a fixed clamping of the front wall and the intestines removed ulcer with a clip. Continuous seam sutured obvivnym piercing the wall in the opposite direction colon, and then connect the beginning and end of the ligature (3). Double-stitched seam peritoniziruyut serous-muscular interrupted or continuous sutures (Figure 4).
EXAMPLE OF EXPERIMENTAL PERFORMANCE
Chronic experiments conducted on nine adult dogs weighing 6 to 11 kg. Under kalipsolovym anesthesia performed laparotomy, the front wall of the duodenal bulb method diotermokoagulyatsii operating perforation diameter of 5 mm, bowel wall in the region of the perforation z-shaped seam is sewn, bulged for ligation, and below the perforations in the cross direction by 10 mm in the intestine superimposed clamp with brackets for fixing the elastic walls of the colon was excised. Under staples tool gut to stitch a continuous U-shaped seam vikrilom under sponges tool crossed, fixed in the clamp, and part of the intestine is removed from the tool, and a duodenum wall at the site of excision stitched piercing obvivnym seam in the opposite direction. After tightening the beginning and end of the ligature tied. Three animals second row imposed nodal sero-muscular sutures, and at three - continuous sero-muscular suture. The operative excision and suturing the intestine was 14 ± 3 minutes. Postoperatively, animals which produced front wall excision duodenum closed method, there were no complications.
Morphological studies conducted 21 days after surgery showed no effects of peritonitis and abdominal walls excised healing duodenal elastic scar.
In 3 animals excision of duodenal wall produced without the use of an open method of sealing clamp with a separate hemostasis and suturing the intestine walls nodal proshivnymi seams from the lumen of the intestine and the second row of sero-muscular sutures. Morphological studies conducted on day 21 revealed in two local animal seroplastic peritonitis, hyperemia and infiltration of the edges of the wound sutured duodenal ulcers.
Flow atraumatic suture in suture stitched double row in animals who underwent excision of the intestine sutured and closed method was considerably smaller. He matched the material flow into two nodal joint.
Thus, the economic efficiency of the piercing continuous seam increases with increasing length fragment excised intestine.
EXAMPLES OF CLINICAL APPLICATIONS
Patient K., 32 years old, medical history 12980/1206, was admitted to the clinic 27.08.03 was diagnosed with a chronic duodenal ulcer bulb complicated hemorrhage of II degree. During emergency EGD detected ulcer anterior wall of the duodenal bulb diameter of 5 mm with a fixed bundle of blood and the presence of bowel content type "coffee grounds". Since 2001, he treated about duodenal ulcer. Against the background of a hemostatic, replacement, integrated anti-ulcer therapy 8.29.03 of the patient noted decreased blood pressure, hemogram parameters and the control EGD marked recurrence of bleeding from the ulcer edge. 29.08.03 made of operation - laparotomy, resection of duodenal ulcers, abdominal drainage. Excision of ulcers of the front wall of the duodenal bulb made within 10 mm from the edge of the ulcers in the intestinal elastic clip with an additional fixing in the transverse direction gut wall. On the fixed jaw in the gut imposed a continuous piercing U-shaped seam, and after excision of intestine ulcers sewn in the opposite direction obvivnym seam. The beginning and end of the ligature tied. Line double piercing seam peritonizirovana nodal sero-muscular sutures. The duration of stage stomach operation was 15 minutes. The postoperative period was uneventful, 10.09.03 was discharged for outpatient follow-up care, the produced 19.09.03 EGD. The pathological changes were found in the stomach. The pyloric sphincter and the duodenal bulb is not deformed. The walls of the resilient bulb. Motor-evacuation function of the stomach and duodenum usual.
Excision of complicated ulcers anterior duodenal wall closed by using an intestinal clamp with extra elastic intestine fixation was performed in 14 patients. Private method of excision of ulcers anterior duodenal wall simplify its implementation, reduce the likelihood of becoming infected wounds intestine and abdominal cavity, reduced operation time and expense of suture in a double stitched seam number, extended the possibility of using excision surgery.
CLAIM
surgical method of treatment of complicated ulcers of the front wall of the duodenum, including their excision, characterized in that the excising and suturing ulcers produce closed by using a clip, in the working jaws of which are two brackets elastic fixing sutured duodenal wall, wherein a clamping straps duodenal wall pierced continuous U-shaped seam is cut off flat in the nip of the front of the bowel wall ulcer and removed from the clip, sewn intestinal wall at the site of excision piercing obvivnym suture in the opposite direction, connect the beginning and end of the ligatures, ending overlay manual double continuous tufting seam.
print version
Publication date 29.03.2007gg
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