SU948376A1 - Method of lowering large intenstine at extirpation of straight one - Google Patents

Description

The invention relates to the field of medicine, namely surgery, and concerns operations for rectal cancer.

There is a known method of bringing the colon down by extirpating the direct by mobilizing the left half of the colon and fixing it to the skin of the perineum 11.

However, with a known method possible necrosis of the colon was reduced and intestinal obstruction.

The aim of the invention is the prevention of necrosis of the reduced gut and the elimination of intestinal obstruction.

The goal is achieved by the fact that in the implementation of the method for lowering the colon when extirpating directly by mobilizing the left half of the colon and fixing it to the skin of the perineum, a graft is formed from the descending colon and. sigma, while the descending colon is crossed above the mouth of the inferior mesenteric artery at a distance equal to the distance from the skin of the primordial to the mouth of the inferior mesenteric artery, then the graft is rotated 180 around the inferior mesenteric artery and after stitching on the skin of the descending colon The guts expel sigma through an additional incision in the left iliac region, together with the proximal end of the colon, fix them and the unnatural anus is dropped out of the brink.

The method is carried out as follows.

The patient is placed on the back with

10 bent towards the abdomen (lOO-llo) and legs spread apart.

The abdominal cavity is opened with an incision from the pubic symphony to the navel, bend around it to the left and continue upwards.

15 to 5-7 cm.

Perform an audit of the abdominal cavity on the spread of the cancer process. If there are no metastases in the organs of the cavity, then a 20-fold cut is made above the aorta at the mouth of the inferior mesenteric artery and continue up the left colonic artery to the splenic angle and down to Douglas-shaped space. Next, the cut 25 continuation of the transition fold

peritoneum on the other side of the mesentery and upward along the lateral kangsha parallel to the descending colon to the phreno-colonic ligament. Diaphragmatic colic ca a

Claims (1)

30 cu intersect between clips and bandage with catgut. The sigmoid colon is brought into the wound. The type of vascular structure of its mesentery is carefully studied. The inferior mesenteric artery and the same vein at the site of the first sigmoid artery are retracted. At the border of the lower and middle third, the sigmoid gut is ligated with two ligatures on the site 1,5 of them. Mobilization of the rectum begins from the back wall. Cut it off from the armchair along with its own fascia. The rectum lateral ligaments are cut with scissors between the clamps and tied or electrocoagulated. Anterior wall mobilize mainly from the perineum. Then, the anus is sutured, a 2.5 cm retract from the sutured anus is removed with a cassette suture, and the skin and subcutaneous tissue is dissected to the pelvic floor muscles with a borderline incision. Bleeding vessels are sutured and tied up with catgut. Careful hemostasis prevents dissemination of cancer cells. Dissect the coccycophalus. The perineal wound is connected to the pelvic. From here, the portions of the pelvic floor of the pelvis are alternately taken in portions, we are maximally close to the pelvic walls and cut through them and are tied up with catgut. In case of insufficient hemostasis, electrocoagulation of the preparation's vessels, dissected levator surface and sacral fascia is carried out. Mobilization of the anterior wall of the rectum is carried out synchronously from the side of the abdomen and perineum. The previously transferred sigmoid colon is crossed between the ligatures. The ends are treated with iodine and torn off with rubber caps. The cut-off portion of the sigma with the mesentery, the rectum with the tumor in its own fascia and the levator are removed through the crotch wound. The pelvic cavity is washed with an antiseptic solution. From the mouth of the inferior mesenteric artery, the distance from the perineal skin to the mouth of the inferior mesenteric artery is measured along the ascending branch of the left tristocis artery. At this level, across the descending colon, a clamp is applied for 5-7 minutes with the capture of the main vessel (with your large intestine-artery). With jiocTaTO4HOM blood supply, the color of the intestine above and below the clamp does not change. The descending colon KHuiKy is tied up on both sides of the clamped clamp, cut through, the ends are smeared with iodine and covered with rubber caps. In most cases, in order to successfully bring down the descending rim of the intestine, the left colic artery is crossed at the dividing site, to the ascending and descending branches. Thus, a graft is prepared, ready for relegation to the perineum, consisting of the descending colon and part of the sigma. The graft is deployed clockwise 180 degrees around the inferior mesenteric artery. The end of the graft, referring to the descending colon, is pulled through the pelvic cavity to the abdominal area and is stitched to the skin of the interjacent wound. The ends of the descending intestine and sigma remaining in the abdominal cavity, through an additional cut in the left iliac region, are brought to the skin in the form of a temporary double-barreled unnatural anus. Drain the pelvis rubber tube. Perineal wound. Dry tightly until the colon is reduced. The edge of the pelvic peritoneum is hemmed to the wall of the descending colon. The abdominal cavity is sutured tightly. Impose aseptic dressings on wounds. An unnatural anus is sutured extraperitoneally after a course of Radiation, after osteoperative therapy. The drainage tube is removed from the pelvis for 4-6 days. The stitches on the stomach and perineum are removed for 12-14 days. The use of the proposed method. The ba provides the possibility of lowering the descending colon to the perineum with an unfavorable anatomical type of its structure, the method prevents necrosis of the reduced intestine and eliminates intestinal obstruction. The invention of the method for colonization by extirpation of the colon by mobilizing the left half of the colon and fixing it to the skin of the perineum, characterized in that, in order to prevent necrosis of the colon and prevent intestinal obstruction, a graft is formed from the descending colon and sigma In this way, the descending colon is crossed above the mouth of the inferior mesenteric artery at a distance equal to the distance from the perineal skin to the mouth of the inferior mesenteric artery, then transplant is rotated. that 180 around the inferior mesenteric artery and the skin after podishvani crotch downlink colon 59483766 output sigma through additional sources of information, incision in the left iliac region and taken into account during the examination together with the proximal end of the rim-L, Fedorov VD Cancer pr my gut Noah guts, fix them and protivos-M., Medicine, 1979,: p.203-209 natural anus is sutured extraperitoneally. (prototype).