| 摘要 |
FIELD: medicine. ^ SUBSTANCE: invention relates to surgery and can be applied for operative treatment of patients with complicated ulcer disease of stomach and esophagus. Laparoscopy, during which diameter of perforated opening and length of inflammatory infiltrate from edges of perforated opening are measured, is performed. On the basis of obtained data perforated ulcer is classified in the following way: if diameter of perforated opening. ëñ 2 mm, I class is determined, >2 mm and ëñ5 mm - II class, >5 mm and ëñ10 mm - III class, >10 mm - IV class; if measured length of inflammatory infiltrate is ëñ5 mm, class A is determined, if it is >5 mm and ëñ10 mm - class B, if it is >10 mm - class C. On the basis of determined classes methodology of laparoscopic suturing of perforated ulcer is selected and performed: in case of IA, IB and IIA class opening is sewn with one Z-shaped suture with absorbable thread; in case of IC or IIB class, opening is sewn with separate one-row sutures with absorbable thread, in case of IIC, IIIA or IIIB class, opening is sewn with separate two-row sutures: the first row with absorbable thread, the second row with non-absorbable thread, in case of perforated gastric ulcer of IIIC, IVA, IVB or IVC class, opening is sewn with separate two-row sutures: the first row with absorbable thread, the second row with non-absorbable thread, then terminal branch of left trunk of vagus nerve is visualised - Latarget nerve and selective proximal vagotomy is performed from proximal Latarget nerve towards esophagus on small curvature by means of ultrasonic scissors. ^ EFFECT: method makes it possible to reduce risk of recurrence, ensure early regeneration of tissues ^ 2 ex |
