SU1333312A1 - Method of plasty of esophagus with stomach - Google Patents

Abstract

The invention relates to surgery. The purpose of the invention is to improve the blood supply to the proximal parts of the graft and ensure its sufficient mobility. Mobilize the greater curvature of the stomach 1 and dissect the gastrocolic euku and transitive fold of the peritoneum. Displace the peritoneum and the fiber lying above the left gastric artery 5 and vein. The preparation is conducted to the level of dichotomy of the left gastric artery and the fusion of the branches of the left gastric vein. The branch 6 above this fork forwards to the proximal stomach and esophagus. The branch 7 of the left gastric artery is skeletonized. Cut out the graft 9 so as to preserve the branches of the untransformed vessels entering the intramural network. Cross the right gastric artery 10 and form the stem of the greater curvature. The cardiac and proximal sections of the stomach are removed. The graft is placed in the posterior medial Bed and anastomosis is formed with the esophagus on the neck. 1 il. About 9 (L oo with so with so to

Description

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one

The invention relates to medicine, namely to surgery, and can be used for operations on the esophagus.

The aim of the invention is to improve the blood supply to the proximal by separating the graft and to ensure its sufficient mobility, which is achieved by crossing the right gastrointestinal artery, the esophageal and fundamental branches of the left gastric artery while maintaining its main trunk.

The drawing shows a diagram of one to 15 radios.

The method is carried out as follows.

The greater curvature of the stomach is mobilized along its entire length, at the same time cutting through the gastrocolic ligament with preservation of the large peri-gastric arch 2 and the same Pyloric Ulcers. The stomach is cranially reclined. Cut through the transitional fold of the peritoneum, covering the upper edge of the pancreas 3, at the level of the celiac trunk 4. Lying above the left gastric artery 5 and vein, the peritoneum and fiber. The preparation is conducted to the level of dichotomy of the left gastric artery and the fusion of the branches of the left gastric vein. A branch 6, which leads to the proximal stomach and esophagus, is tied up over this fork and skeletons the descending branch 7 of the left gastric artery. The stomach is placed in its original position, the skeletization of the descending branch of the left gastric artery is supplemented anteriorly to the segmental vessels 5, three of which are ligated and cross at the entry point into both the anterior and posterior walls of the stomach. At the same time, two segmental branches 8 are kept, which are guided from the left

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gastric artery in the distal regions of the stomach. Accordingly, the ligated vessels are cut out and the graft 9 is cut out in such a way as to preserve the derived branches of the untransformed vessels entering the 13th intramural network.

Perevaly and cross the right gastric artery 10. A stalk is formed from the greater curvature associated with the distal part of the stomach, removed (using the NLCA apparatus or another 13333122

This pathway involves the cardia and proximal part of the stomach, adjacent to the lesser curvature. Mobilize the duodenum along Kocher. The graft is placed in the posterior diastolic bed and simultaneously anastomosis is formed with the esophagus on the neck.

The method was introduced into clinical practice and was used for operations in 18 patients.

Example. Patient N., 55 years old, was in the clinic on 03/01/84 to 03/29/84.

03/15/84 Operation: laparodiafragomi, mediastinotomy cervix on the left, esophagus extirpation. Posterior nonmediastinal plastic esophagus with isoperistaltic stalk of the stomach. Esophagogastrostomy on the neck.

Produced laparotomy, diaphragmotomy. From the side of the abdominal cavity, the esophagus is mobilized to the level of the trachea bifurcation. Shane mediastinotomi is produced on the left, the mobilization of the esophagus is definitive, its resection ..

A graft is formed from the greater curvature of the stomach with preservation of its distal part. The right gastric, short left gastroepiploic vessels are ligated and crossed. The rights of the gastro-septic and left gastric artery after ligation and the intersection of the esophageal and two segmental branches of it, are preserved. guiding the proximal part of the lesser curvature of the stomach. The duodenum was mobilized according to Kocher. The graft is laid in the posterior diastolic bed, formed esophagogastrostomy on the neck. Drainage of the left pleural cavity, posterior mediastinum and abdominal cavity by air-jet drains, wound closure.

The postoperative period was uneventful. Nutrition through the transnasal probe started on the 4th day. Zoo.nd removed on the 8th day, started feeding through the mouth.

Radiographically :, liquid contrast passes freely through the anasto30

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Moe, through the stomach and intestines. Barium overflow is not detected.

Wounds were affected by primary tension. Discharged in a satisfactory condition on the 14th day after the operation.

Moe, through the stomach and intestines. Barium overflow is not detected.

Wounds were affected by primary tension. Discharged in a satisfactory condition on the 14th day after the operation.

Esophagoplasty by an isoperistaltic stalk of the stomach with preservation of the left gastric artery ensures reliable blood supply of the transplant, sufficiently long for imposing an anastomosis on the neck, {confirmed experimentally and clinically with pressure measurements in intramural vessels.

The use of this technique prevents the complications associated with inadequate blood supply to the graft, its insufficient length. The distal part of the stomach is incorporated into the digestion.

Esophagoplasty is carried out in one stage, due to which the duration of hospital stay is reduced. The location of the graft in the posterior mediastinum is more physiological and has cosmetic advantages.

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The proposed method is recommended for practical use.

Claims (1)

Invention Formula The method of plastics of the esophagus by the stomach, including mobilization of the stomach with preservation of the right gastroepiploic artery, formation of a tubular isoperistaltic stem from the greater curvature of the stomach with its subsequent movement and imposition of the esophago-gastric anastomosis, which is aimed at improving the blood supply of the proximal transplant and ensuring its mobility during mobilization, the left gastric artery is retained, while its esophageal and fundal branches and the right stomach are crossed. chnuyu artery.