SU1635967A1 - Method for cholecystectomy - Google Patents

Abstract

The invention relates to abdominal surgery and can be used in diseases of the gallbladder. The purpose of the invention is to prevent complications both during surgery and in the postoperative period. The bottom of the gallbladder capture fenestrated clip. Two bordering side cuts at a distance of 1.2-2 cm from the point of transition from the liver to the gallbladder and connecting in the form of a drop at the mouth of the gallbladder dissect the serosa and produce a subserous detachment of the bladder from the bottom, moving downwards to cross the seams only at its wall. The Hartmann pocket and cystic duct are distinguished. After removal of the gallbladder and intraoperative studies of the bile ducts, the stump of the duct is peritonated with the serous sleeve. Supply drainage. The method avoids complications both during surgery and in the postoperative period.

Description

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with

The invention relates to abdominal surgery and can be used in diseases of the gallbladder.

The purpose of the invention is to reduce trauma by preventing intraoperative damage to the elements of the bladder.

The method is carried out as follows.

Under general anesthesia, an upper median laparotomy is performed. The bottom of the gallbladder capture fenestrated clip. Two bordering side cuts at a distance of 1.5-2 cm from the point of transition from the liver to the gallbladder and connecting in the form of a drop at the mouth of the gallbladder dissect the serosa and produce a subserous detachment of the bladder from the bottom, moving downwards, crossing the seams only at its wall to avoid damage to the liver parenchyma. If necessary, separate the bleeding branches of the cystic artery are ligated, the Hartmann pocket is isolated, and the cystic duct simultaneously around the circumference to the point of inflow into the common bile duct. If the serosa fold makes it difficult to further excrete the duct, then it is somewhat cut along the front surface, which facilitates its further excretion. The cystic duct is crossed at the jaws and ligated at a distance of 0.5 cm from the place of inflow into the common bile duct. After performing all the necessary intraoperative studies of the bile ducts, the stump of the duct reliably re-tonizes the serous coupling formed, through which the drainage is supplied with uncertainty about its reliable ligation. PRI me R. Sick With 59 years, was admitted to the hospital with complaints of permanent OU

from VI

shchi (july in the right hypochondrium, subfebrion / low temperature, general malaise, dry mouth. The study revealed marked pain in the right hypochondrium, the intense gall bladder was determined. Blood: hemoglobin - 112 g / l, leuke. - 10.8 g / l, fell - 8%, lymph. - 4%, segmen. -88%, ESR – Yum / h. Bilirubin 13 μmol / l.

Under peridural anesthesia, chernesredinnaya laparotomy was performed. The gallbladder is enveloped in the omentum and covered with fibrin overlays. When separating the omentum, about 5–7 ml of serous (about effusion. Bubble stressed, cherry-purple color with whitish patches. Stone wedged in the Hartmann's pocket. A bubble was punctured, 60 ml of gray pus with colibacillary odor removed. Two bordering side cuts at a distance of 1.5-2 cm from the point of transition from the liver to the gallbladder and connecting as a drop at the mouth of the gallbladder were cut off the serosa, the gallbladder with the Harman pocket was subserously separated by traversing it from the bottom walls as well subserous around the circumference - the cystic duct, which was crossed at the clamps, ligated at the base, the stump was covered with the serous sleeve formed. There was no bleeding from the vascular bladder. the period proceeded smoothly. The temperature returned to normal on the third day. The patient was allowed to sit down on the second, move on the third and on the 10th day after the operation was discharged in a satisfactory condition. After 1.5 years produced control

infusion cholangiography: rbvnye ducts, 0.8 mm wide.

The proposed method of cholecystectomy was applied in 32 patients, 21 of them were operated on for acute cholecystitis (phlegmonous - 9, gangrenous - 5, perforative - 2, catarrhal - 5), and 11 for cholelithiasis and chronic cholecystitis. There were no complications.

The application of the proposed method significantly reduces the invasiveness of the operation, as it allows the operation to be performed without ligation of the cystic artery and desertion of the common bile duct, completely eliminates damage to the liver tissue, extrahepatic bile ducts and blood vessels, eliminates the development of neurinomas, the preservation of the long stump of the cystic duct and The serous coupling reliably peritonizes the stump of the duct and allows locally to bring in catching drainage when it is unreliable.

The method of operation is recommended to a wide range of surgeons performing operations on the liver and extrahepatic bile ducts.

Claims (1)

Invention Formula A method of cholecystectomy, including subserous gallbladder discharge from the bottom of the duct stump cover with local serous integuments, characterized in that, in order to reduce the trauma by preventing intraoperative damage to the elements of the bladder, the serous membrane of the bladder is opened 1.5-2 cm from its transition from the liver to the bladder by side bordering cuts, which are connected as a drop at the mouth of the gall bladder, after which the stump of the duct of the bladder is immersed in the formed subserous sleeve.