| 摘要 |
FIELD: medicine. ^ SUBSTANCE: invention relates to medicine and can be used for duodenum stump formation in case of gigantic complicated circular ulcer. Anterior wall of bulb duodenum is dissected orally to the boundary of resection, and aborally from perforation hole to stenosis line. Posterior wall of duodenum is separated in acute way 1.0 cm from distal edge of ulcer crater, penetrating into head of pancreas. Uninterrupted inverting serous-muscular-serous suture is applied, with the first stitch being made on posterior wall of intestine capturing serous-muscular layer at the distance 0.3 cm from distal edge of ulcer crater, penetrating into head of pancreas, "fixer" knot is tied up, restoring integrity of peritoneal cover of intestine wall. After that, 4-5 stitches of uninterrupted inverting serous-muscular-serous suture are applied without penetration into intestine lumen and submerging ring of ulcer stenosis inside. Last prick in is made at the distance 2.0 cm from stenotic hole. Thread is tightened until tissues contact and second "fixer" knot is formed. With the same thread in reverse direction at the distance 0.5 cm from the first line of suture the latter is submerged by means of blanket serous-serous suture, with tightening until tissues contact, and tidying up the end of thread with thread of the first "fixer" knot. At the distance 1.5 cm cranially and caudally from the line of suture two coaptation serous-serous interrupted sutures are applied. Threads of the first and second "fixer" knots are tied to each other, submerging suture line inside. After that, resection of stomach in accordance with one of modifications Bilrot-2 or Roux is performed. ^ EFFECT: method makes it possible to reduce risk of inflammation development, reduce risk of cutting through sutures. ^ 3 ex, 5 dwg |
