SU1593638A1 - Method of forming pancreatic-esophogojejunostomy - Google Patents

Abstract

The purpose of the invention is to increase the biological integrity and mechanical strength of the anastomosis. Disable the loop of the jejunum. Cross the pancreas laterally. At the same time, on both sides of the Wirsung duct, the gland tissue is excised in a wedge-shaped manner, an excess duct of up to 1 cm is formed and a layer of gland tissue up to 5 mm thick is left on the duct. The stump of the gland on both sides of the duct is sutured. At the cut-off end of the intestine, the sero-muscular sheath is peeled off from the mucous-submucosal over 4 cm. Excess of the inner cuff is excised, leaving a strip up to 1.5 cm wide. The inner case is sutured one third, the pancreatic duct is immersed in it. Fix the inner case to the gland tissue around the duct. The outer cuff is put on the pancreas, tuck the edge of the cuff and fix it to the gland. 5 il.

Description

The invention relates to medicine, namely to pancreatic surgery, and can be used in the treatment of patients with diseases and injuries of the pancreas.

The purpose of the invention is to increase the physical and biological tightness of the pancreatic-small-intestinal anastomosis.

With the proposed method, the jejunum loop is disconnected, the pancreas is wedge-shaped on both sides of the Wirsung duct, leaving a gland parenchyma layer on it, the pancreatic stump is sutured, two cuffs are formed from the sheath of the jejunum; After that, the stump of the gastric gland is covered with a sero-mucular cuff, the edges of which are folded and fixed to the gland with a continuous mattress suture.

FIG. 1 is a diagram of the wedge resection of the pancreas to the sides of the main duct and closure of the stump of the gland in FIG. 2 is a diagram of the formation of a serous and mucosal and mucous and submucous cuff with partial removal of the latter in FIG. 3 is a diagram of the partial closure of the inner cuff from the mesenteric edge; in FIG. 4 - scheme invasl with

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ginification into the lumen of the intestine of the virsung duct of the pancreas with partial stitching with a mattress suture of the inner cuff to the pancreatic stump; in fig. 5 is a diagram of the shelter of the pancreatic stump with the outer cuff of the intestine, the edges of which are tucked and fixed by a continuous mattress suture to the gland.

The method is carried out as follows.

I Resection of the pancreas is performed wedge-shaped on both sides of the main duct, leaving part of the organ tissue thick: up to 5 mm and the formation of an excess of pro-: Current up to 1 cm. atraumatic; 4/0 silk thread needle. The ends of the filaments along the edges of the pancreatic stump) to; the glands are not cut off. The serous and median layers are cut around the circumference: the loops of the jejunum, taken at a distance of 25-30 cm from the treittse ligament. ; The outer sheath, which includes the serous, and constricted layers, is separated from the submucosal layer. Over the course of A, see: At the level of the proximal end of the inner body, intersect and intersect the stump; -; Net and Z-shaped seams. The cuff of the intestine is retained with a cuff of up to 1.5 cm from SUSPENSIVE GI and SLI; the cystic layers; the excess is dissected; the outlet loop is fed through the mesentery window of the transverse colon; to the cult of the pancreas. The inner case with one third of the lumen is sutured with a double silk thread with a 3/0 Schmiden seam. The threads are tied up. Then, with these same threads, mattress sutures (2-3) are placed on the skeleton and the inner case: one is behind the main pancreatic duct, the other is in front of it. When the filaments are tightened, the duct invaginates into the lumen of the intestine. The threads are tied up. The marginal filaments of the suture to the stump of the pancreas and the sutured inner intestinal sheath are bonded. The anastomosis line is covered with a cuff of serous and muscular layers, for which man-. the socket is stretched and put on the pancreatic zhedezu. At the same time, the edges of the cuff are folded in order to achieve the contact of the serous layers of the intestines and pancreas.

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and fixed to the gland with a continuous mattress suture on a 4/0 atraumatic needle. The duct of the jejunum is sutured to the edges in the mesentery of the transverse colon. The operation is completed by the imposition of an anastomosis between the leading and discharging segments of the jejunum below the pancreas anastomosis by 40 cm.

The method was tested in an experiment on 25 animals (dogs) with bacteriological control using the washout method from the pancreatic-intestinal anastomosis area and the small intestinal anastomosis, from the jejunum lumen to the pancreatic-small anastomosis area and from the outside surface of the free loop lying away from the anastomosis. The mecha- nal strength of anastomoses was studied by the method of pneumopression. The control set on 25 animals, which anastomosis is made according to the method prototype.

According to bacteriological studies, the degree of infection of swabs from the anastomosis line and serous cover of the free small intestine loop on the ward on the third day is significantly less with the pancreas-small intestinal anastomosis, performed by the proposed method, compared to the anastomosis according to the method-prototype.

These pneumopressions showed that physical tightness in the pancreas. Small bowel anastomosis was significantly higher with the proposed method than with the prototype method.

Thus, the pancreas-intestinal anastomosis of the proposed method has a higher biological integrity and mechanical strength, reduces the destructive effect of pancreatic juice and intestinal contents on the tissue from which the fistula is formed.

Recommended for clinical use.

Claims (1)

Invention Formula A method of forming pancreatic-intestinal anastomosis, including transverse resection of the pancreas, leaving an excess Phage.1 2 0ue. i