SU906526A1 - Method of appltcation anastomosis at esophagus plasty by stomach - Google Patents

Description

(5) METHOD OF APPLICATION OF ANASTOMOSE IN VENTRIC PESTINE PLASTIC

I

The invention relates to medicine, namely, thoracic surgery.

There is a method of imposing an anastomosis in a plastic esophagus-stomach, which involves moving the stomach into the chest cavity and forming a submersible anastomosis. Uil layers and gives a large percentage of postoperative complications, such as inconsistency of anastomotic sutures, cicatricial stenosis.

The purpose of the invention is to prevent esophageal stenosis and simplify the operation.

The goal is achieved by the fact that according to the method of imposing an anastomosis in the plastic surgery of the esophagus by the stomach, including the movement of the stomach in

The chest cavity and the formation of the immersion anastomosis, the esophagus is crossed at an angle of 5 in the frontal plane, then the walls of the esophagus and stomach are stitched, the anastomosis is finally formed by suturing the stomach wound, which is then fixed to the anastomosis and mediastinal pleura.

The method is carried out as follows.

ten

The operation begins with laparotomy. On opening the abdominal cavity and its revision proceed to the mobilization of the stomach. Mobilization begins with the separation of the gastrocolic ligament in

15 places of its attachment to the intestine, while carefully preserving the right and left gastroepiploic artery and their arterial arcs, running along the greater curvature of the stomach.

20

Claims (1)

The left gastro-epiploic artery is crossed directly at the place of its discharge from the splenic artery. The gastro-splenic ligament is then divided and the short arteries of the stomach in the spleen are intersected. Gastric secretion is continued by separation of the gastrophrenic ligament. The next step is to continue to distribute the gastrocolic tissue in the distal section to the initial part of the duodenum. After that, the greater curvature of the stomach becomes mobilized with the preservation of the arterial arch along it. The stomach is retracted up and to the right and ligation of the left gastric artery at the place of its discharge from the celiac artery, in order to avoid arc damage along the lesser curvature of the stomach, try to keep large branches of the lower diaphragmatic artery along with it. After discharge, the stomach can be moved to the neck. In cases where the stomach is small and the size of the proposed imposition of anastomosis is quite high, an additional mobilization of the duodenal ulcer is performed according to Kocher, which makes it possible to lengthen n (stomach 4-6 cm. Mobilization of the stomach is supplemented with Dmur-Burden type pylorosplasty Thus, the consequences of high vagotomy are eliminated in advance.Then the abdomen of the esophagus is mobilized, the esophagus ligamentous apparatus with the diaphragm is mobilized, the esophageal opening is expanded without dissecting the diaphragm, and It is easy to move the stomach into the chest cavity and preserve the integrity of the diaphragm. Having convinced of the viability of the gastric graft, careful hemostasis, draining and draining the abdominal polka through a puncture of the left hypochondrium, cutting new The drainage stage is completed by suturing the laparotomy wound. The patient then turns to the left side and performs a thoracotomy from the posterior-lateral approach without resection of the ribs. After the chest cavity is opened, a revision is made and the level of damage to the esophagus is determined. Then the mediastinal pleura is opened and the esophagus is isolated from surrounding tissues according to the standard technique. 4 When the esophagus is highlighted for the required length and the stomach is pulled out through the dilated esophageal opening of the diaphragm into the chest cavity, the esophagus is cut off from the stomach, sometimes with a cardia site. The wound of the stomach is sutured in the usual way using the apparatus, RO-BO. The stump of the esophagus is reclined upward and the stomach is under it. Proceed to the imposition of the esophago-gastric anastomosis. When performing it, the following rules are observed: firstly, the blood supply of the organs being stitched is optimally maintained: secondly, when the anastomosis is applied, any tension of the organs being stitched is avoided when they are stitched, this is ensured by sufficient mobilization of the stomach; thirdly, it tends to flawlessly stitches in the anastomosis zone. The bottom of the stomach is fixed to the left side wall of the esophagus by three rows of knotted sutures, using the kapron thread No. 3 as a suture material. Then the esophagus is crossed in an oblique direction, at an angle ifS from top to bottom from the right side surface to the left. As a result, the entire plane of the cut-off of the remaining part of the esophagus is facing the surgeon. This creates the most favorable conditions for the subsequent application of the anastomosis. Then, an incision of the sero-muscular layer of the stomach 1 cm away from the edge of the esophagus is made, the upper ends of this incision are in the shape of the Latin letter V should reach the level of the upper point of the plane of intersection of the esophagus. Then through all layers of the stomach and esophagus around the entire circumference of the esophagus impose nodal catgut sutures. The anastomosis is performed on a thick probe inserted into the esophagus. We begin to sew from the extreme upper sutures, vcol is made from the side of the mucous membrane of the esophagus, and protrusion through the wall of the stomach to the dissected sero-muscular area. Thus, the mucous membranes of the esophagus and the stomach, after dissection, the stomach wall is well matched, and the suture is knotted into the lumen of the anastomosis, which creates the most favorable conditions for tissue growth in the anastomosis zone. At this anastomosis finish. The wound of the stomach is sutured according to generally accepted rules. Thus, the entire suture line is rejected by the wrapped stomach wall. Since the lumen of the anastomosis will face the lesser curvature of the stomach, it, when filling the stomach, functions as a valve preventing the gastric contents from reflux into the esophagus. Then the stomach is placed in the bed of the esophagus and the individual sutures are fixed to the copper of the astinal pleura and to the diaphragm. The chest cavity is drained by rubber drainage and sutured in layers. The proposed anastomosis method simplifies and facilitates the technique of its versions, increases the reliability of 66 operations and prevents the subsequent stenosis of the esophagus. Claims The method of applying an anastomosis in the plastic of the esophagus with the stomach, including moving the stomach into the chest cavity and forming a submersible anastomosis, characterized in that, in order to prevent esophageal stenosis and simplify the operation, the esophagus is crossed at an angle of the frontal plane, then the walls of the esophagus and stomach are stitched, finally Anastomosis is formed by suturing a wound of the stomach, which is then fixed to the anastomosis and mediastinal pleura. Sources of information taken into account in the examination 1. Surgeons wounds of the esophagus. Ed. IN AND. Kazan, 1973, C.V232238.