RU2318459C1 - Method for forming cystoduodenoanastomosis - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: the present innovation deals with treating pancreatic pseudocysts. One should fulfill duodenotomy followed by puncturing a pancreatic cyst. Out of the site of the puncture mentioned it is necessary to lance the cyst due to V-shaped incision, the segments of the incision are of 3 cm length being at the angle of 60° against each other. The cyst should be lanced through median duodenal wall being under the major duodenal papilla. One should apply sutures by capturing duodenal wall and cystic fibrous capsule; duodenal hiatus should be sutured, as well. The innovation provides prophylaxis of the reflux of duodenal content into the cavity of pancreatic pseudocyst due to avoiding the yawning anastomosis, forming a valve and, also, crossing orbicular muscles upon the least duodenal segment while applying cystoduodenoanastomosis.

EFFECT: higher efficiency.

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Description

The invention relates to medicine, namely to surgery, and can be used in the treatment of pancreatic pseudocysts (PPC).

Currently, in the treatment of AUC, internal drainage operations are widely used. In particular, when the pseudocysts are located in the region of the pancreatic head, the most physiological option is the operation to form cystoduodenoanastomosis (CDA).

The prototype was chosen "Operation cystoduodenostomy" described by Yu. B. Martov, V. V. Kirkovsky, V. Yu. Martov [Acute destructive pancreatitis. - M .: Medical literature, 2001. - 80 S.] and shown in figure 1. The disadvantage of this method is that when the longitudinal CCA is formed, the circular muscles of the duodenum intersect for at least 5 cm, and this contributes to the gaping of the anastomosis and the possible throwing of duodenal contents into the AUC. Duodenal reflux prevents the obliteration of the pseudocyst cavity.

In order to prevent this drawback, the authors have developed and introduced into clinical practice a method for the formation of CDA.

The technical result of the proposed method is that a V-shaped CDA is formed, the upper flap of which acts as a valve, which reduces the casting of duodenal contents into the cavity of the AUC. Also, the intersection of the circular muscles in a smaller segment of the duodenum contributes to a decrease in reflux. All this contributes to the subsidence of the walls of the PPC and its obliteration.

The method is as follows: the stages of the operation preceding the formation of the CDA do not differ from those described in the prototype. The mouth of the large duodenal nipple is identified (Fig. 2, a) and the puncture point of the PPC is determined, which should be located 3 cm below it. After the puncture, from the side of the duodenal lumen, the PAC cavity is opened from the puncture point by a V-shaped incision, segments of which are 3 cm, are located at an angle of 60 ° to each other (Fig.2, b). The formation of the CDA is completed by cross-linking the dissected intestinal walls and the PPK capsule with a continuous or nodular single-row suture. Thus, the length of the superimposed CDA is 6 cm. The upper flap of the V-shaped CDA (FIG. 2, c), which acts as a valve, contributes to a decrease in the reflux of the duodenal contents into the cavity of the AUC. The closure of the duodenotomy wound does not differ from that described in the prototype.

Example. Patient K., 55 years old, I / B No. 1695, was admitted to the clinic on March 19, 2006 with complaints of pain in the upper abdomen, frequent vomiting, weight loss. When fluoroscopy of the stomach and duodenum revealed a compression of the descending part of the duodenum due to the enlarged head of the pancreas (figure 3). When performing ultrasound diagnosed cavity formation in the projection of the head of the pancreas with a size of 5.6 × 4.8 cm (figure 4). As planned, on March 26, 2006, an operation was performed - the application of a V-shaped cystoduodenoanastomosis. In the postoperative period, on the control echogram on 04/06/2006 in the region of the head of the pancreas (in place of the pseudocyst), a formation of dimensions 3.0 × 3.1 cm without a cavity component is determined (figure 5). The patient was discharged in satisfactory condition, patency of the duodenum was restored, the cavity of the pancreatic pseudocyst is not visualized.

The proposed method for the formation of CDA has the following advantage.

The upper flap of the V-shaped CDA, acting as a valve, as well as the intersection of the circular muscles in a smaller segment of the duodenum contribute to a decrease in the reflux of the duodenal contents into the cavity of the AUC and its obliteration.

Claims (1)

A method of forming cystoduodenoanastomosis, including duodenotomy, puncture and opening of a pancreatic cyst through the medial wall of the duodenum below the large duodenal nipple, suturing the wall of the duodenum and fibrous capsule of the cyst, followed by suturing of the duodenum; V-shaped cut, segments of which, 3 cm long, are located at an angle of 60 ° to each other.

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