SU1232222A1 - Method of forming valvular biliodigestive anastomosis - Google Patents

Description

The invention relates to medicine, in particular to surgery, and can be used in the treatment of obstructive jaundice by restoring the flow of bile into the digestive tract.

The purpose of the invention is to prevent postoperative complications by preventing reflux and fistula structure by forming a valve from the walls of the bladder above the anastomosis.

Figure 1-4 reflects the main stages of the operation: figure 1 - the selection and the formation of the tube of the gallbladder; Fig. 2 shows the initial stage of valve formation; FIG. 3 shows the final stage of valve formation; figure 4 - formed anastomosis, General view.

The method is carried out as follows.

The gallbladder 1 is gradually and carefully, especially near the neck, acoustically separated subserously or together with the bed as with cholecystectomy from the bottom. At the same time it is absolutely necessary to preserve the supply vessels. Then a tube 2 is formed from the gallbladder, for which the N.Zh.K.AZZ device is superimposed on the selected gallbladder so that when it flushes the walls of the gallbladder, the deserated part 4 must be cut off. apparatus N.ZH.K-A., has well-known advantages over manual stitching. After the mechanical suture has been applied, the latter is peri- tonized by the nodular gray-serous sutures 5. The task of the next moment of the operation is to calibrate the internal opening of the anastomosis. To do this, a tube 6 with a diameter of 0.8-1 cm is inserted into the lumen of the bubble. Next, two pouch sutures 7 are placed in the middle of the formed bubble, which are tightened and tied on a rubber tube, which allows a certain diameter of the inner hole 8 to be established. anastomosis. Subsequently, 4 invaginating sutures 9 are applied. While the operator is tying these seams, the Assistant invades the proximal part 10 of the plastic tube from the gallbladder with anatomical tweezers into its distal section 11. At the same time, it forms an inkwell non-watering The last stage of this operation is the imposition of an anastomosis between the distal end of the plastic tube from the gallbladder and the stomach or the initial part of the jejunum in the "end to side" type. At the same time, the width of the anastomosis 13 is 3-4 cm, and the diameter of the internal opening of the anastomosis is 0.8-1 cm.

Example. Patient M. was admitted to the hospital with a diagnosis of mechanical jaundice.

Complaints to the yellowness of the sclera and skin, severe skin itching, bad zones. The duration of jaundice is 45 days.

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The patient's condition is severe, marked cholemia (226.7 µmol / L). After the infusion-detoxification therapy, the patient underwent the operation: laparotomy. Duodenotomi. Cone valve cholecysto-gastrostomy. Biopsy.

A duodenal tumor was detected at the operation with a transition to the head of the pancreas and metastasis to the para-aortic lymph nodes. A tumor site was taken for histological examination (adenocarcinoma). The gallbladder is enlarged due to overflowing of the bile (Courvoisier symptom). The case is recognized as inoperable. It was decided to perform a palliative operation for internal discharge of bile. The gallbladder is isolated from the bed subserous "from the bottom to the neck. The apparatus N.ZH.K.A cut off the deserous part and formed a plastic tube (diameter 4 cm) from the gallbladder. In the middle of the formed tubular bubble, two pouch sutures were placed after insertion of a 0.8 cm diameter rubber tube from the distal end of the tube into the lumen to calibrate the anastomosis inner hole, the pouch sutures are attached to the tube. Rubber tube removed. The narrow part of the plastic tube is invaginated in the distal direction with the help of four sutures. The invagination line is strengthened by four interlocking gray-serous sutures. A cone valve of the non-spill type ink tank formed. The distal end of the tube is anastomosed with a stomach of the type “end to side. The width of the anastomosis is 3.5 cm. In this case, the internal opening, i.e., the opening in the valve area, does not participate in the formation of the anastomosis and is located 0.5 to 0.7 cm more proximal to the anastomosis line.

The postoperative course without features. The good drainage function of the anastomosis is indicated by the fact that the intensity of jaundice has progressively decreased, on day 5 after surgery the amount of bilirubin in the blood was 158.2 μmol / l, on day 10 - 84.1 μmol / l, on day 15 - 23.8 μmol / l

The body temperature was raised only in the first days after the operation, and later normalized. With a control radiography of the stomach and duodenum, barium suspension is not thrown into the biliary tract. The patient was placed on the right side for 10–15 min, i.e., there was an attempt to obtain a provoked entero-biliary reflux, but even in this case the barium was not thrown into the biliary tract. The patient was discharged on day 18 after surgery in a satisfactory condition with a slight icteric staining of the sclera.

The proposed 5-way anastomosis between the gastrointestinal tract and the gallbladder is simple and reliably prevents the bile ducts from being cast.

they contain gastrointestinal contents, which saves the patient from the terrible postoperative complication - cholangitis. The wide outer diameter of the anastomosis provides prevention of its structure.

The method was applied in 6 patients with good immediate and remote (up to 1.5 years) results.

The method is recommended in surgical practice.

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Claims (1)

METHOD FOR FORMING VALVE BILIODIGEST ANA STOMOSA, including the isolation of the gallbladder, the formation of a tube from it, characterized in that, in order to prevent postoperative complications by preventing reflux and anastomosis, the valve is formed from the walls of the bladder above the anastomosis, while a tube with a diameter of 0.8 is inserted into the lumen of the formed tubular bladder -1 cm, reduce the lumen of the bubble in its middle during the application of at least two purse string sutures to the diameter of the inserted tube, after which the tube is removed and the narrowed part is invaginated in the distal direction, then the bladder anastomose with the stomach or intestine. Fig. 1 SO N5 N3