SU1362460A1 - Method of choledochoduodenostomy - Google Patents

Description

This invention relates to medicine and may be used in bile-excretory tract surgery.

The purpose of the invention is the prevention of inconsistency of the choledochoduodenal adenosis and the development of peritonitis, which is achieved by using in the early postoperative period drainage obturators, which are installed more maximally and distally than the anastomosis.

The drawing shows the scheme of implementation of the method.

 The method is carried out as follows.

An upper median laparotomy is performed. After cholecystectomy Through the air-conducting duct 6 of the hepatocholedochial drainage, air is introduced into the balloon 5. The latter is smoothed out, taking the form of a shchara and an obtourism at the same time, the lumen of the hepatocholum. The free end of the hepatoholedrchyal drainage is brought out through contraception in the right hypochondrium. Then, the gastroduodenal drainage 8 with the balloon 9 is placed nasogastrally into the duodenal rash 7 of the gastroduodenal drainage 8, which is set in the bulb of the two duodenal ulcers 10 and fixed by the well-known method at the external orifice of the nose .; Through the air-conducting channel 11 of the gastroduodenal drainage, air is introduced into the balloon, which expands to take the shape of a ball and obturar. The bulb of the duodenum is twelve. Gastric and duodenal secretions are evacuated through openings 12 and 13 in the duodenal 14 and gastric 15 drainage channels of the gastroduodenal obturator. Both drainage channels of the channel are not communicating with each other, they function autonomously. Evacuation of bile from the hepatocholedochus is carried out through the openings 16 in the drainage canal 17 of the hepatocholedochial drainage obturator. Removal of obturator drainage in a smooth postoperative course is performed on the 5th

62460

day by ordinary sweating. The outflow of their removal restore the free communication of the obturator balloons through

, air-conducting channels with the external environment.

Example, Ill. T., 63 years old, was admitted with complaints of pain in the right hypochondrium. I fell ill on 12/09/85, 10 when, after errors in the diet, I had acute pains in the right hypochondrium, vomiting with food eaten with an admixture of bile. 12/10/85 g appeared yellowing sclera. The intensity of yellow smoke began to increase. History of jaundice, which passed on its own.

The general condition of the patient is moderate. Skin and sclera

20 icteric. Pulse 102 beats per minute, satisfactory, filling and voltage. The abdomen is involved in the act of breathing, painful on palpation in the epigastric region and right sub25 rib. Symptoms of peritoneal irritation are absent.

 Diagnosis: acute cholecystopancreatitis, mechanical jaundice.

After preoperative preparation

30 produced upper median laparotomy. During a revision of the abdominal organs, a phlegmonically modified gallbladder containing many calculi and a thickening of the pancreas head were revealed. The choledoch is up to 2.1 cm in diameter, and a calculus is palpated in its terminal part. . Performed by cholecystectomy transduodenal lithotomy with

40 overlay choledochoduodenostatic disease. Through the stump of the cystic duct in the hepatocholedoch proximal. choledochoduodenostomy was introduced hepato-choledochial drainage in which balon-obtu

The controller is located in the

SRI. Drainage is fixed in the stump of the cystic duct with a single catgut suture. Through the air-conducting duct-hepatocholedochial drainage, the air into the balloon, so that the latter straightened, took the form of a ball, and occluded the hepatocholedochal lumen. The free end of the hepatoholedochial drainage is derived through contraception in the right hypochondrium. „

Rye. Then it was inserted through the nose into the duodenal bulb, gastro-duodenal drainage with the balloon obturator in a collapsed position proximal to the choledochoduodenostomy. Gastroduodenal drainage is fixed at the external opening of the Nose. Through the conduit of its channel, the air was fed to the balloon, which straightened, took the shape of a ball, and occluded the bulb of the duodenal ulcer. Surgical wound sutured in layers.

The postoperative course of a smooth drainage obturator of the common bile duct and duodenum removed on the 5th day after the operation. The postoperative wound healed by primary tension. The patient was discharged in satisfactory condition on the 8th day. Complications are not noted.

Thus, the proposed method is simple and easily accessible, allows to reduce the risk of postoperative complications, including

including the development of peritonitis. At the same time, the terms of stay of patients at hospital treatment are reduced. Recommended for practical use.

Claims (1)

Invention Formula The choledochoduodenostomy, which includes external transcystic drainage of the extrahepatic biliary tract, is associated with, in order to prevent malfunction and development of peritonitis, transnasal drainage of the stomach and duodenum is additionally performed, and the obstructive lumen of the ventriculum will be treated with a lacteal ventricle, which is obstructed by a lumen of the stomach and duodenum. the gut is right behind the gatekeeper.