METHOD FOR OPERATIVELY TREATING DIFFICULT-TO-REMOVE DUODENAL ULCERS

摘要

FIELD: medicine; surgery. SUBSTANCE: in order to prevent incompetence of duodenal stump after Roux stomach resection, to treat complicated duodenal ulcer and also in case of chronic duodenal ileus, proposed method recommends to practise suprapyloric stomach resection, followed by formation of terminoterminal pylorojejuanastomosis with help of mobilized Roux segment. Same segment is also used for applying terminolateral gastrojejunanastomosis, but latter is positioned more distally in relation to pyporojejunanastomosis. Continuity of small intestine is restored by using enteroenterostomy practised at distance 30 cm from gastroenteroanastomosis. Excessive pressure in duodenum is eliminated by organizing its retrograde drainage. Latter fact is important for prophylaxis of afferent loop syndrome. Suprapyloric resection makes it possible to use tissues unaffected by inflammatory process for decompressive pylorojejunanastomosis. Stomach resection lower boundary is passed some 1-2 cm orally in relation to pylorus. EFFECT: proposed method was used to operate 4 patients with good proximate and remote results. 3 dwg