SU1132923A1 - Method of placing esophagojejunoanastomosis - Google Patents

Abstract

THE METHOD OF IMPLEMENTATION OF EZOPHOGOJUNA ANASTOMOSIS, including the formation of a fistula of the end of the esophagus in the intestine flank, y-shaped shutdown of the abduction segment of the small intestine using its free proximal segment to cover the anastomosis line, which is designed to reduce the tension of the anterior wall of the esophagus and prevent reflux esophagitis, a u-shaped cut-off is made after the formation of the posterior wall of the anastomosis, and during the formation of its anterior wall, the free proximal end is sewn into the anastomosis zone at the same time, the anterior and posterior wall of the loop are sutured, respectively, with the anterior wall of the esophagus and the anterior wall of the abdomen. oo yu yu SAE

Description

The invention relates to medicine, mainly gastrointestinal surgery, and can be used in the treatment of patients with organic diseases of the stomach and esophagus.

There is a known method of applying an esophago-junction anastomosis, which consists in the fact that after removal of the stomach the erecting and withdrawing knee of the squeeze loop is removed. The esophagus anastomoses vertically end to the side with the retractable knee. The driving knee overlaps the anterior surface of the esophagus and the front lip of the anastomosis, stitching it with the retracting knee. A brown anastomosis is placed between the retractile and distended knee of the intestine distal to the esophageal anastomosis. The essence of the method lies in the formation of a serous canal around the esophagus stump and the closure of the anterior lip seams with the knee of the fine sore 1.

The method has significant drawbacks.

Tension of the tissues along the anterior lip, leading to the eruption of the Stitches and the formation of inconsistency, during the formation of the anastomosis, the active contents of the duodenum do not prevent the anastomosis zone; the anterior lip of the anastomosis does not have an anti-reflex mechanism. These drawbacks predispose to the development of the inconsistency of the schvast anastomosis and reflux ezaphagitis.

There is also known a method of applying esophagojejunoanastomosis, which includes the following techniques for the formation of the Ru segment of the small pischa (Y-shaped shutdown), suturing the end opening of the Ru route isolated along the esophagus and the Roux-isolated segment of the end-to-side small intestine, covering the anastomosis line in the region of its anterior lip with the free end of the Roux-isolated segment of the small intestine 2.

However, the known method does not prevent reflux esophagitis. In addition, when the method is performed, tension arises in the anterior wall of the esophagus, which in the future may lead to inconsistency of the anastomosis.

The aim of the invention is to reduce the tension of the anterior wall of the esophagus and prevent reflux esophagitis.

The goal is achieved by the fact that, according to the method of imposing esophagojunoanastomosis, including the formation of the end of the esophagus end in the gut flank, a образshaped cut off of the abdomen of the fine peel using its free proximal segment to cover the anastomosis line, the shaped cut-off is produced after forming the posterior wall of the anastomosis, and during the formation of its anterior wall into the anastomosis zone, the free proxy end of the outlet loop is wrinkled, while its anterior and posterior wall is sshchivayut with the anterior wall of the abdomen.

The method is carried out as follows.

The back lip of the esophageal anastomosis is formed with a discharge loop (Fig. 1). Stitches the adductor and the abacus segments to the level of the end of the esophagus, leading to the dissection of the cross (Fig. 2). Next, the edges of the anterior walls of the esophagus and the free proximal end of the abduction of the digoras (Fig. 3) are stitched, several stitches are also placed on their Q anterior walls, fixing the free proximal end of the intestine around the esophagus (Fig. 4). The formation of the anastomosis is completed by stitching the remaining semicircles of the ends of the esophagus and the intestine (Fig. 5).

The y-shaped cut-off of the kyschka loop is completed with anastomosis according to Brown (Fig. 6).

Example. Sick B, 47 years old, history jVs 5304, operated on 11/24/82, diagnosis: stomach cancer. Made gastrectomy with the imposition of esophagojejunostomy according to the described method. Nipple drains are connected to the esophageal anastomosis. Abdominal wall injury to drainage. The postoperative period in the patient proceeded smoothly. On the 14th day after the operation, the patient was discharged from the clinic in a satisfactory condition.

The example shows the practical feasibility of the proposed method.

The positive effect of the method is that the most frequent cause of the failure of the anastomosis of the esophagus is the tension of the tissues on the anterior lip of the anastomosis, as this stitch is located at the same projection level of the esophageal tissue of the intestine ; a valve mechanism is created along the anterior lip of the pin of the evodo-kischechnogo anastomosis. This valve mechanism prevents the development of reflux esophagitis.

In 3 patients operated on with the proposed method, no reflux esophagitis or inconsistency of the sutures was observed.

The method is recommended in clinical practice.

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FIG. five

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Claims (1)

METHOD FOR APPLICATION OF EZOPHAGOYUNOANANASTOMOSIS, including the formation of an anastomosis of the end of the esophagus into the side of the intestine, U-shaped disconnection of the outlet segment of the small intestine using its free proximal segment to cover the anastomosis line, characterized in that, in order to reduce the tension of the anterior esophagus wall and prevent reflux esophagus a y-shaped shutdown is performed after the formation of the posterior wall of the anastomosis, and when the formation of its anterior wall, the free proximal end of the outlet is sewn into the anastomosis zone loops, while stitching its front and back walls, respectively, with the front wall of the esophagus and the front wall of the discharge intestine. (L Figure 1