METHOD OF SELECTIVE PROXIMAL VAGOTOMY

摘要

FIELD: medicine.;SUBSTANCE: invention refers to medicine, namely to abdominal surgery, and can be used for surgical treatment of duodenal ulcer. Method of selective proximal vagotomy comprises extraction of upper edge of esophageal opening of diaphragm, mobilization of stomach bottom, skeletonisation of left pedicle of diaphragm, intersection of ascending gastric artery, dissection of small curvature of stomach and cardia in direction from angle of stomach to cardia with intersection of transverse neurovascular gastric branches, denervation of abdominal part of buzzer, separation of the right pedicle of the diaphragm and posterior shaft of the vagus, closing of bare muscles of small curvature of the stomach with serous-muscular sutures to the cardia, stapling of the esophagus, cardia and stomach bottom by the method of side invagination. After separating the upper edge of the oesophageal opening of the diaphragm in the avascular zone, a gastro-colonic ligament and a soldering process are cut between the posterior wall of the antral portion of the stomach and the pancreas to the pylorus. That is followed by dissecting the peritoneal adhesions between the posterior wall of the stomach and the pancreas to the upper end of the stomach bottom. Further, the gastro-pancreatic ligament is dissected and the pancreas is completely separated from the splenic vessels and nerves from the posterior wall of the stomach and gastro-splenic, gastro-diaphragmatic ligaments. Pancreatic tail is separated from gastroesolenic ligament in direction from cardia to spleen gates with visualization of short gastric arteries. Stomach is pulled downwards and to the right, and between a back wall of a stomach and a pancreatic gland a hand of the surgeon, palm to a back wall of a stomach is entered. Hand is delivered to the spleen gates and separated by the stomach, gastro-splenic and gastro-diaphragmatic ligaments from the pancreatic gland with splenic vessels and nerves. Ends of the fingers of the same hand are used to grip the edge of the stomach bottom and pull down the gastro-splenic ligament down to visualize the fingertips through it and through the gastro-diaphragm ligament. Gastro-splenic ligament, in avascular zone of its middle part, is dissected simultaneously longitudinally from end of stomach bottom to gates of spleen. Medial portion of the gastro-splenic and gastro-diaphragmatic ligament is transected towards the esophagus throughout their thickness. That is followed by performing a skeletonisation of the left pedicle of the diaphragm, for this purpose an esophagus-diaphragm ligament is dissected towards the oesophageal opening of the diaphragm, and an ascending gastric artery is transected. It is followed by denervation of low curvature of stomach, cardia and abdominal esophagus. Posterior vagally shaft is separated. Naked muscles of small curvature of stomach are closed and cardiofundoplikation is performed.;EFFECT: method provides reducing traumatism by excluding the possibility of intraoperative damage of the pancreas, spleen and its vessels, prevention of postoperative complications – discoordinated disorders of gastric motility ensured by dissection of adhesions throughout the posterior wall of the stomach from a pylorus to a cardia and a stomach bottom, simplification of surgical intervention technique, reduction of operation time.;1 cl, 1 ex