RU1806631C - Method for pancreatogunostomy after resection of right part of gland - Google Patents

Abstract

The invention relates to medicine, namely to abdominal surgery, and can be used for the application of pancreatojejunoanastomosis after resection of the right side of the gland. SUMMARY OF THE INVENTION: A loop of the intestine is shot in the form of a double-barreled barrel and anastomosed according to Brown, a stub is placed on the adducting knee below the anastomosis, the abdominal knee is dissected, a section of the stump of the gland is immersed into it, and fasciculate cell tissue is captured into the sutures by pancreatic anastomosis. formation behind the gland, during the formation of the anterior lip, the peritoneum covering the gland in front, then the anastomosis is peritonized, hemming the free part of the leading knee to the peritoneum covering the gland in front, and stitching the area intestine over the top and under the bottom edges of the gland. 4 ill.

Description

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The invention relates to medicine, namely to abdominal surgery.

The purpose of the invention is to prevent the inconsistency of the sutures of pancreatojejunoanastomosis after resection of the right part of the gland by reducing the invasiveness of the intervention and peritonization of the anastomosis of the jejunum loop isolated and turned off from the passage.

In FIG. Figures 1-4 show the steps of the method during pancreatoduodenal resection followed by pancreatodigestive anastomosis.

The method is carried out as follows.

In FIG. 1 shows that after laparotomy and removal of the right side of the pancreas to the stump 1 of the gland, a loop of jejunum 2 is drawn through a window into the mesocolon,

which is sutured with a double-barreled barrel (Fig. 2) over a length of 10-12 cm. Then (Fig. 3) the leading end of the intestine 3 is drowned out by applying circular ligature and peritonization of the obstruction site with 4 interrupted sutures. 6-7 cm below the plugs form an interloop anastomosis 5 according to Brown. Dissect the outlet portion 6 of the isolated loop of the intestine 2 against a section of the stump 1 of the gland (Fig. 1). The posterior lip of the anastomosis is formed by suturing the wall 8 of the outlet part of the intestine 6 with fascial-cellular formations 7 behind the gland. Form the front lip of the anastomosis (figure 2). stitching the wall of the intestine 8 with the peritoneum 9. covering the gland in front, thereby immersing a section of 1 gland into the lumen of the intestine 6. Peritonize the anastomosis (figure 4), stitching the free part 3 of the leading knee to the peritoneum 9, covering the gland with

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di, and stitching sections of the intestine 3 and 6 above the upper 10 and below the lower 11 edges of the gland.

Example. Patient N., medical history No. 6854, was hospitalized in the abdominal surgery department of the clinical hospital Ns 4 in Kiev for a tumor of the pancreatic head. After preoperative preparation is operated. Verkhnesredinna laparotomy. During the audit: the tumor comes from the head of the pancreas, is removed. The histological conclusion of the biopsy material is adenocarcinoma. No distant metastases were detected. Indications for pancreatoduodenal resection are established. The resection stage of the operation was performed with removal of the right side of the pancreas at the isthmus level and complete. removal of the duodenum. A loop of the jejunum was drawn through the window into the mesocolon, the antireflux choledochojejunoanastomosis was placed on the proximal end, and the indentation was about 35 cm longer than the intestine and sewn with a double-barreled gun, the outlet part of which was placed under the cut of the gland stump, opposite which the intestine was opened. The posterior lip of the anastomosis was formed by stitching the dissected edge of the intestine with fascial cell formations behind the gland. Then, the front lip was formed with an anastomosis, stitching the intestine with a peritoneum covering the gland in front. They started ligatures, immersing a section of the stump of the gland in the lumen of the intestine. The leading end of the intestinal loop was drowned out according to A. Shalimov. and turned him out of the passage with an inter-intestinal anastomosis along Brown. The anastomosis was peritonized, hemming the free part of the adducting knee to the peritoneum, covering the gland in front and stitching the sections of the adducting and abducting knees of the isolated loop above the upper and lower edges of the stump of the gland, Indent 25 cm downwards, gastrojejunostomy end to side was performed. Glove and tubular drains were inserted through contrapertures in the Ipancreato-testitious anastomoses. The laparatoma wound was sutured tightly. Postoperative course without complications. Wound healing by primary intention. Drainage from the abdominal cavity was removed on the 16th day. The patient was discharged in satisfactory condition, examined after 4 months. Body weight increased by 4.6 kg. Investigated the incretory and excretory function of the gland. Their condition is recognized as satisfactory.

In the proposed method of pancreatojejunostomy after resection of the right side of the pancreas, a less traumatic stitching of the pancreatic stump with a duct into the lumen of the intestine with peritonization of the anastomosis is provided

a loop of the jejunum turned off from the passage, which excludes stenosis of the pancreatodigestive joint, reduces the likelihood of pancreatic necrosis along the suture line, allows anastomosis of any size stump of the gland with the intestine, eliminates the tension and deformation of tissues in the joint area, which together provides conditions for uncomplicated healing of the formed anastomosis.

Claims (1)

The claims A method of pancreatojejunostomy after resection of the right part of the gland, including stitching of the isolated intestine and transverse section of the stump of the gland. This is because, in order to reduce the number of postoperative complications by reducing the invasiveness of the intervention, preventing the incidence of anastomosis and pancreatic necrosis, they sew a loop guts in the form of a double-barreled barrel and anastomose according to Brown, put a stub on the adducting knee below the anastomosis, dissect the abduction knee, immerse a section of the stump of the gland in it. When forming the lip, pancreatic junior anastomosis in the sutures capture fascial-cellular formations behind the gland, when forming the anterior lips - peritoneum covering the gland in front, then peritonize the anastomosis by suturing the free part of the adducting knee to the peritoneum, covering the gland in front and stitching portions of the intestine above the upper and lower edges of the gland,