SU952236A1 - Method of treating postoperational structures and hepaticodoch deffects - Google Patents

Description

The invention relates to medicine, namely to hepatology, and is intended for the surgical treatment of non-neoplastic diseases of the external bile ducts.

A known method of treating postoperative strictures and defects of the hepatocholus, in which the second mobilizes the proximal segment of the hepaticocholedochus, expands its opening by cutting the scar tissue with a continuation of the incision into its constant wall, then the proximal section of the hepaticocholedochus anastomizes with the loop of idle chickens and anesthetic loops of idlers. anastomosis P tl3.

However, after the implementation of the known method of hepaticojejunostomy, anastomosis is often scarred, which is caused by the absence of epithelium in the area of the anastomosed surfaces. To prevent it, it is necessary to use drains for a duration of 6-12 months. With such a reconstruction, bile enters the jejunum, a duodenal mine. That means: the optimal conditions of digestion are collapsing, the possibility of occurrence of cholangitis, ceptic ulcers is created, because of this the recovery time of patients is prolonged. Frequent relapses of strictures make the operation conditionally radical.

The aim of the invention is to prevent operative complications and relapse of the disease (cicatricial stricture).

The goal is achieved by implementing the method of treating postoperative strictures and defects of the hepaticocholedochus, including mobilization of the proximal segment of the hepaticocholedochus, turning off the jejunum loop from the food passageway by applying a y-shaped anastomosis followed by drainage of the hepaticholedochus, drawing, drawing, and drawing a wyth of an anastomosis, drawing a wedge-shaped anastomosis followed by drainage of the hepaticcholedochus, drawing, a drawing loop, a drawing loop, an opening loop, a drawing loop, a patch, an opening loop, a patch, an opening loop, an opening loop, an opening loop, an opening loop, an opening loop, an opening loop, an opening loop, an opening loop and an opening loop, an opening loop, an opening loop and an opening loop of the pathway. the distal segment of the hepaticocholedochus, excised ruddy tissue, then the posterior walls of the segments of the hepaticocholedochus are sutured, and the remaining defect vayut serous surface loop of jejunum ..

The method is carried out as follows.

Claims (1)

After mobilization, the proximal | 1st segment of the hepaticocholedochus below the stricture turns off the jejunum loop from. passage of food by anastomosis by Pu. tightly sutured aperture of this loop, mobilization of the distal segment of the hepaticocholedochus below the stricture, excision of the Cicatricial tissues and stitching of the posterior wall of the hepaticocholedochus. Then drainage is carried out to the hepaticoledoch above and below the transhepatic defect or through the puncture of the invariable wall of the distal choledochus. The remaining wall defect of the hepaticoholedochus is sutured with the serous surface of the jejunum loop, which is turned off from the passage of food. The second end of the drainage is brought out through the puncture of the wall wall. It is removed 2 weeks after surgery. PREMIER Ill S., 19 years old, was admitted to the hospital with a complaint: MI on the yellowness of the skin, itching, weakness. Cholecystectomy was performed, jaundice appeared after the operation. After 2 months produced hepaticojejunostomy. The condition was satisfactory. After 2 g, jaundice, chills, weakness appeared. After an examination in the clinic, a diagnosis was made: cicatricial stricture of helacticoanostomy, biliary cirrhosis. Surgery with general endotracheal anesthesia. Produced lapartomy in the right hypochondrium with excision of the postoperative scar. Separation adhesions. During revision, the liver is enlarged, the greenish-brown color of the previously applied hepaticojejunoanostomosis on the off loop of the jejunum, intestine, P is stenosed is dense. The gut is disconnected from the common bile duct, which was clogged with putty and small stones. Defect of intestinal wall sutured by double seams. Defect of the biliary tract along the entire circumference of a length of about 2-2.5 cm. Their back semicircles are sewn together. A transhepatic drainage through the left hepatic duct was performed. The defect in the wall of the anterior semicircle of the bile ducts is sutured by the serous surface of the jejunum, turned off from the Ripri passageway of the previous operation. As a result, a hepatico-choledochial anastomosis was created on the transhepatic drainage with plastic repair of the defect of the jejunum's transverse surface. Transhepatic drainage is brought out through the peritoneal wall. Conducted drainage in the subhepatic space, the drainage in the subphrenic space through the left hypochondrium. Laporatomy wound of the anterior abdominal wall sutured. Held transdrainage cholan-. hyography — through the drainage, the bile ducts are fully formed. Evacuation of contrast to the duodenum is free. The patient was discharged in a satisfactory condition. Examined 2 months after discharge. Drainage removed 1.5 months ago. The condition of the patient is good, the patient has gained weight. No complaints. Total blood bilirubin and 0.8% mg. Chills, jaundice no. Sick almost healthy. Thus, when implementing the proposed method, as a result of using the body's own tissues, indicated by the epithelium, for plastics of the defect, the scarring of the bile ducts does not develop. This makes the operation radical. There is no need for long. drainage and biliary tract, which significantly reduces recovery time. Preservation of the natural pathway of bile flow provides optimal digestive conditions, eliminates the possibility of the development of peptic ulcers and cholangitis. The method of treating postoperative strictures and defects of the hepaticocholedochus, includes mobilizing the proximal segment of the hepaticoholedochus, turning off the jejunum loop from the food passageway by applying a y-shaped anastomosis, followed by draining the hepaticoholedochus, and I will have the precontinued –––––––––––––––––––––). (cicatricial stricture), the opening of the loop of the jejunum is sutured, then the distal segment of the hepaticocholedochus is mobilized, the scar tissue is excised, ATEM crosslinked rear wall segments hepaticocholedochus and the remaining defect sutured serosal surface jejunal loop. Sources of information taken into account in the examination 1. Shalimov AS and others. Surgeons of the liver and bile ducts. Kiev, Medicine, 1975, pp.197-2 0.