Patent RU-2214167-C2 (RU)
Inventor: ZHERLOV G K
IPC: A61B8/00
Filed: 2001-11-05
Granted: 2003-10-20
Abstract: FIELD: medicine. SUBSTANCE: method involves carrying out transabdominal examination of surgical intervention area at the valve projection after filling the stomach with marker substance. Then, geometrical shape of the valve is determined, functional condition of the duodenum and valve is evaluated in the course of marker passing and evacuation from the stomach and gastroduodenal reflux availability is determined. To do it, duodenum wall thickness is measured by applying ultrasonic method. Anatomical structure of the formed gate valve and surrounding tissues, its position, metric characteristics of structural units belonging to it are determined. Lumen size between valve top and internal surface of the duodenum are recorded during various stages of evacuation process. Regional blood circulation in the gate valve area is determined using color and energy Doppler mapping. Content movement direction from the duodenum is determined using visual control and color Doppler scanning for gastroduodenal reflux availability. Normal state of gate valve is considered to be the case, if the duodenal lumen size is found not greater than 20 mm, wall thickness not greater than 3 mm and peristalsis reaches 8-15 contractions per 1 min, the gate valve is visible on the background of taken liquid on the internal surface of the duodenum in longitudinal ultrasonic cross-section immediately behind the gastroduodenal anastomosis as uniform formation of moderate echogenicity of triangular shape with broad base on the internal surface with valve height being equal to 14-18 mm and base width to 5-7 mm, lumen size being equal to 5-7 mm between valve top and duodenum wall in the course of visually controlling valve function and its mobility when stomach stump content passes into the duodenum and when gastroduodenal anastomosis lumen is closed with valve wall mucosa from the distal lumen side with duodenogastric reflux being prevented under duodenum contraction condition and, when applying Doppler mapping of anastomosis surroundings, no duodenum reflux content into the stomach stump and availability of developed capillary arterial and venous network. Duodenostasis signs being observed as duodenum lumen increased beyond 20 mm, overexpansion caused by the contents, feeble peristalsis of less than 8 contractions per min and wall thickness being greater than 3 mm, enlarged metric characteristics of the gate valve in longitudinal ultrasonic slice as increased base width greater than 14 mm, valve height less than 14 mm, increased lumen size between valve top and opposite surface of the duodenum more than 7 mm, structure uniformity disorder as echogenic inclusions in submucous layer, no mobility of gate valve fold with its top turned from the anastomosis towards duodenum wall when stomach stump content passes in distal direction and lost fold mobility towards the closure of distal edge of gastroduodenoanastomosis under duodenum contraction condition and available duodenogastric reflux in this case without distinct observation of blood circulation in the valve area when applying Doppler mapping, recording extraorganic complications like pathological fluid congestion beyond the formed pylorus-modeling gastroduodenoanastomosis, pathological state of gate valve is considered to be the case. EFFECT: enhanced effectiveness in determining the right treatment tactics. 5 dwg, 1 tbl