SU1703075A1 - Method for performing esopahgoplasty - Google Patents

Abstract

This invention relates to medicine, namely to surgery. The purpose of the invention is to reduce the number of complications due to the formation of gstrostomy in the neck, and to ensure the nutritional status of the patient in case of insufficiency of esophagogastroanstomosis. Put stalked gastrostomy 1 on the proximal stomach. After preoperative radiotherapy, the esophagus is resected and the esophagostomy is formed in the neck. After some time, a laparotomy is made, cutting the stem from the greater curvature of the stomach along line 3, starting from a point, 2 cm more proximal than the anastomosis between the gastro-epiploic arteries and not reaching the pylorus about 4 cm. Cross the stomach from the middle of the lesser curvature along line 4, perpendicular to the stem, from the greater curvature, tightly sutured, held in the subcutaneous tunnel on the neck, and pscno are patched next to the esophagostomy. A stalked gastrostomy is formed from the site of the antrum 7, which leads to the abdominal wall through the right right muscle. The esophagogastroanastomosis is delayed. 2 il .....-

Description

.

The invention relates to the field of medicine, namely surgery, and can be used in the restoration of the esophagus after resection. . The aim of the invention is to reduce the number of complications caused by the formation of gastrostoke on the chez, and to ensure the nutritional status of the patient in case of a lack of theophagastrostomystomy. ; five:;:, - ,;--;. -; ::,:. -h, -,

v After resection of the esophagus, cardiac and proximal parts of the lesser curvature and formation of the isoperus of the stalk from the greater curvature, they create a stalked gastrostomy from the intestinal part of the stomach, and the artificial esophagus, which has been extended to the neck, is sutured in heat until anastomosis is applied ... ; -,:, ...-.:; ... ... -V -:

FIG. Figure 1 shows the stomach after resection of the esophagus with a previously laid stalked gastrostomy and lines — cutting the stems from the greater curvature and antrum of the stomach; in fig. 2 - formed stems and esophagostoma.

The method is carried out as follows. .. ;. .-; . -

Impose stalked gastrostomy 1 na.proximal stomach. After preoperative radiotherapy, the esophagus is resected and the esophagus 2 is formed on the neck. After some time the laparotomy is made, the stem is cut from the greater curvature of the stomach along line 3, starting from a point 2 cm proximal to the anastomosis between the gastric and arteries and not reaching the pylorus about A cm. Cross the stomach from the middle of the minor the curvature along the line-4, perpendicular to the line 3 of the formation of the stem from the greater curvature. The proximal part of the stomach is 5 c. . the earlier gastrostomy 1 is given. The stalk of the greater curvature b, about 3.5 cm wide, is sutured tightly, held in the subcutaneous tunnel on the neck, and is located next to zophogostomy 2. A stalk of the gastrostomy 8 is formed from the section of the northern section 7, which is removed from the wall and the thick wall through the right straight s of its upper third. Delayed esogogastro anastomosis end to the side of the neck.

Example, Patient F., 07/19/88, performed laparotomy. A fold is formed from the anterior wall of the stomach, which is stitched and broken with the help of the apparatus NLC-60, thus forming the stem of the anterior wall of the stomach with the base in its protruding symphysis. Smile the stitching shades sewn by separate shoArles, the stem is brought out through the counteroperture in

left hypochondrium, where the gastrostomy is formed. From 03/08/08 to 09/05/88 held

. radiation therapy with a total focal dose of 40 g. 09.28.88 the lateral torus was filled with

Which is to the right in the intercostal space

The esophagus is isolated from the mediastinum, stitched

apparatus UO-40 in the line of transition to cardia, cut off, chest wall wound sutured

0 tight. The cult of the esophagus is derived on the neck, where the esophagostomy is formed: The postoperative period without complications.

12/06/88 performed plastic esophagus. Produced laparotomy. The stomach is separated from adhesions, mobilized along the major and minor curvatures, the gastrostomy is cut off from the anterior abdominal wall and immersed in the abdomen. In parallel, the greater curvature of the sero-muscular layer of the day and the back of the stomach from the bottom of the stomach to the pylorus along the longitudinal axis of the stomach. By applying the devices NZhKA-60, the mucous-submucosal layer was stitched and cut.

5 large curvature, the end of which is sutured tightly. .-..-- four . . ...

The anterior and posterior walls of the stomach are stitched from the middle of the lesser curvature perpendicularly to the stem using an apparatus

0 PP-40 and the stomach is crossed proximally.

line of stitches formed by a stalk of a small

curvature. The drug, including the proximal part of the stomach with the previously imposed

1 gastrostomy removed.

five . Formed subcutaneous canal before

the sternum where the stalk is held from the big

curvature and is located next to the stump

 esophagus and esophagostomy. The stem of the lesser curvature is derived through counter-perception

0 in the right hypochondrium, where the gastrostomy is formed. Through it, the probe of the distal link of Treitz is about eaten. The postoperative period without complications.

27,01.89 completed the formation of AE5 stomosis. The circumferential incision was excised by an esophagostomy, the top of the stem was mobilized from the greater curvature of the stomach and an anastomosis of the end to side type was formed. On the 10th day, the instability of the anastomotic sutures and the formation of a fistula were noted. Continued feeding through the gastrostomy and more conservative treatment of the fistula, which resulted in its complete closure. The gastrostomy lid silt spontaneously after distance 5 nor zoz.

The method avoids the complications associated with the presence of a gastrostomy in the neck, especially when it is necessary to feed the patient through a probe inserted about the gastrostomy. In case of anastomosis failure, the patient is provided with adequate nutrition and the treatment of the fistula is facilitated.

Recommended for practical use. ,

Claims (1)

Formula of the invention The method of plastics of the esophagus, including the removal of its thoracic, cervical and lesser curvature of the stomach, the formation of zofagostoma on the neck, cutting out the isoperistral stalk from the greater curvature of the chlod, holding the stem subcutaneously to the neck, delayed by 0 Lozhenme zofagogastroanatomosis. characterized in that, in order to reduce the number of complications caused by the formation of a gastrostomy in the neck, and to provide the patient with adequate nutrition in case of anastomotic insufficiency, the stalked gastrostomy is formed from the antrum of the stomach, for which the walls of the stomach are additionally dissected from the middle of the lesser curvature to the cutting line the stem of the greater curvature, and the end of the artificial esophagus on the neck is sutured tightly. 2-4- 1 Schi I