RU2311876C1 - Method for carrying out pancretaoduodenal resection repair stage and concomitant gastrectomy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves using insert produced from vascular prosthesis when forming small intestine anastomosis. Pancreatic duct is drained with silicon tube. The draining tube is introduced into vascular prosthesis lumen. The vascular prosthesis is produced from polytetrafluoroethylene and has 5 cm large diameter equal to duct diameter. Vascular prosthesis opening wall is sutured to the pancreatic duct wall. The draining tube is introduced through separate pierce in the small intestine into the intestine lumen. Intestine wall in the vicinity of intestine opening is sutured to vascular prosthesis wall in the vicinity of the opposite end face opening.

EFFECT: reliable anastomosis connecting small intestine to the pancreatic duct; reduced risk of pancreatic juice activation and suture inconsistency.

Description

The invention relates to medicine, namely to Oncology, and can be used to treat pancreatic cancer and gastric cancer with a transition to the duodenum.

A known method of forming a free intestinal insertion from the loop of the small intestine on the blood vessels, which is used in operations on the esophagus (A.A.Shalimov et al. Surgery of the esophagus. Moscow Medicine, 1975, p.150-152). The above method has a significant drawback. Free intestinal insertion can be used in pancreatic surgery to form pancreatic enteric anastomosis, but it does not prevent the development of anastomosis due to the activation of pancreatic enzymes by intestinal enterokinase.

As a prototype, a method was chosen for performing pancreatotuodenal resection, in which a “reservoir” is created from the small intestine, the lumen of which is anastomosed with the stump of the pancreas, common bile duct, stomach, and the cavity of the reservoir is drained by a nasogastric tube for 1 day and, thus, all digestive juices are removed from the lumen of the gastrointestinal tract (Patyutko Yu.I., Klimenkov A.A., Itin A.B., Samoilenko V.M., Surgery. 1990, No. 2, pp. 133-135 )

The method has significant disadvantages.

1. The method does not provide for the isolation of the pancreatic duct into the intestine.

2. The method does not involve isolation of the pancreas from intestinal enterokinase. As a result of enzyme activation, anastomotic suture line damage occurs.

3. The method does not involve isolated drainage of the pancreatic duct. As a result, active pancreatic juice is located in the area of anastomosed organs, adversely affecting the joints of anastomoses.

The aim of the invention is to prevent the activation of pancreatic juice and to prevent the development of inconsistency of the joints of the anastomosis in the conditions of the short intestinal loop used for reconstruction.

This goal is achieved by draining the pancreatic duct with a silicone tube, draining through the lumen of the vascular prosthesis from PTFE with a diameter equal to the diameter of the duct, 5 cm long, suturing the wall of the end hole in the vascular prosthesis with the wall of the pancreatic duct, through a separate puncture in the wall of the small intestine drain into its lumen, sew the wall of the hole in the intestine with the wall of the vascular prosthesis in the region of the opposite end hole.

The novelty of the invention lies in the fact that the pancreatic duct is sutured into a flexible allogeneic insert, which helps to prevent tension of the joints in the anastomosis zone, as well as isolating the contents of the pancreatic duct from the contents of the small intestine.

Well-known sources of information from the CIS and foreign countries do not contain a method similar to the proposed one for performing the reconstructive stage of pancreatoduodenal resection with concomitant gastrectomy.

"The method of performing the reconstructive stage of pancreatoduodenal resection with concomitant gastrectomy" can be applied in general surgical and specialized oncological hospitals.

The method is as follows.

The pancreatic duct is drained with a silicone tube, drainage is carried out through the lumen of a vascular prosthesis made of PTFE with a diameter equal to the diameter of the duct, 5 cm long. The wall of the hole in the vascular prosthesis is sewn with the wall of the pancreatic duct. Through a separate puncture in the wall of the small intestine, drainage is carried out into its lumen. Sew the wall of the hole in the intestine with the wall of the vascular prosthesis in the region of the opposite hole.

Example:

Patient N-ev, 58 years old, no. Disease 5614 / r was admitted to the Rostov Cancer Research Institute on November 28, 2005 with a diagnosis of gastric infiltrative cancer. When laparotomy detected the transition of a tumor of the stomach to the duodenum. The patient underwent gastrectomy, pancreatoduodenal resection. Due to the short bowel loop, an insert from the vascular prosthesis PTFE was used at the reconstructive stage of the operation to form an anastomosis of the small intestine with pancreatic duct. The pancreatic duct is drained with a silicone tube. A drainage was made through the lumen of a vascular prosthesis made of PTFE with a diameter equal to the diameter of the duct, 5 cm long. The wall of the end hole in the vascular prosthesis with the wall of the pancreatic duct was sewn. Through a separate puncture in the wall of the small intestine, drainage was carried out in its lumen. The wall of the hole in the intestine is stitched with the wall of the vascular prosthesis in the region of the opposite end hole. The postoperative course is smooth. The patient was discharged home on the 12th day.

The technical and economic efficiency of the method lies in the fact that the use of a synthetic insert allows the formation of a reliable fistula between the small intestine and the pancreatic duct. The number of early postoperative complications is reduced, the quality of life of patients is improved.

Claims (1)

A method of performing the reconstructive stage of pancreatoduodenal resection with concomitant gastrectomy, characterized in that when forming an anastomosis of the small intestine with a pancreatic duct, an insert from the vascular prosthesis is used, while the pancreatic duct is drained with a silicone tube, drainage through the lumen of the vascular prosthesis from PTFE with a diameter equal to , 5 cm long, sew the wall of the hole in the vascular prosthesis with the wall of the pancreatic duct, through a separate puncture in the wall of a thin ki CI, drainage in its lumen, gut wall sutured to the hole area with the wall of the vascular prosthesis in the region of its opposite end opening.