Method for carrying out biliary tracts reconstruction

FIELD: medicine.

SUBSTANCE: method involves carrying out rein performing pancreaticoduodenal resection. Cholecystoenteroanastomosis is built. Anastomosis application takes place between the right hepatic duct and gallbladder neck near its flexure.

EFFECT: prevented biliary hypertension.

 

The invention relates to medicine, namely to surgical interventions on the pancreas, the duodenum and bile ducts and can be used for radical surgical treatment of patients with cancer of the gastrointestinal tract in progress pancreatoduodenal resection in narrow thin-walled common bile duct, especially in terms of its high resection and insufficient bandwidth ulcerating duct.

The known method pancreatoduodenal resection, when a narrow thin-walled common bile duct produce suturing his stump, and the internal flow of bile provide cholecystojejunostomy (Danilov M.V. Fedorov, V.D. Surgery of the pancreas. - M.: Medicine, 1995). When bandwidth is low ulcerating duct latter does not provide adequate biliar flow-out that leads to biliary hypertension, mechanical jaundice, failure of welds choledochus.

As a prototype of the selected method of reconstruction of the biliary tract with pancreatoduodenal resection for Brunsviga when the recovery phase of the operation consistently impose cholecystojejunostomy and choledochojejunostomy (A.A. Shalimov, Radzikhovsky A.P., Polupan NR. Atlas operations on the liver, biliary tract, pancreas and intestines. - M: Honey is the Qing, 1979).

The described method has significant drawbacks:

1) does not preclude tension joints choledochojejunostomy that does not provide favorable conditions for its healing;

2) involves stitching hollow organs with a significant difference in the thickness of their walls (common bile duct and jejunum), which complicates the mapping layer when applying choledochojejunostomy and creates conditions for the development of insolvency of fistula and its scarring.

The aim of the present invention is the prevention of biliary hypertension and insolvency seams of the common bile duct.

This goal is achieved by the fact that produce the imposition of anastomosis between the right hepatic duct and the neck of the gall bladder in the region of its bend.

The invention “Method of reconstruction of the biliary tract is new, because it is unknown the level of medicine, namely in surgery diseases biliopankreatoduodenalnyj zone.

The novelty of the invention lies in the fact that produce the imposition of anastomosis between the right hepatic duct and the neck of the gall bladder in the region of its bend.

In the available sources of information in Russia, CIS and foreign countries, we could not find a similar proposed method of reconstruction of the biliary tract with pancreatoduodenal resection.

The invention is the Method of reconstruction of the biliary tract is industrially applicable, as there may be many times repeated and used in health care in the surgical treatment of diseases of the organs biliopankreatoduodenalnyj zone in specialized medical institutions, especially surgical profile.

The method is as follows: when performing pancreatoduodenal resection produce the imposition of anastomosis between the right hepatic duct and the neck of the gall bladder in the region of its bend.

Clinical example:

Patient C.C., 29 years. Enrolled in thoracoabdominal Department of RNII diagnosed with a tumor of the pancreatic head? Pseudotumorous pancreatitis?”. 15 April 2003 was operated. If the audit reveals a tumor in the pancreatic head. Produced pancreatoduodenal resection. When removing drug choledoch was clipped to 3 mm distal to the mouth iscausing duct. The diameter of the hepaticoholedochus at the level of resection of 3 mm, and the thin wall of the duct. Gelceutical duct with a diameter of about 2 mm. flow of bile into the intestine and restored by cholecystoenterostomy with the imposition of the anastomosis between the right hepatic duct and the neck of the gall bladder in the region of its bend. External drainage of the bile ducts was performed according to the type of the suspension of cholecystostomy, the tube is drawn through an anastomosis between the right hepatic bile duct with what usarem in the upper sections of the right hepatic duct. Histological analysis of remote drug - carcinoid. The postoperative period was uneventful. 14-day drainage of the biliary tree removed. On the 16th day the patient was discharged in satisfactory condition.

The proposed method of reconstruction of the biliary tract with pancreatoduodenal resection was used in the treatment of 4 patients. In any case, in the postoperative period complications of biliary anastomoses was not.

Technical and economic efficiency of the method is that the imposition of the anastomosis between the right hepatic duct and the neck of the gall bladder in the region of its bend ensures adequate internal flow of bile, reduces the likelihood of developing septic complications, improves the immediate results of surgical treatment of cancer patients bodies biliopankreatoduodenalnyj zone.

The method of reconstruction of the biliary tract with pancreatoduodenal resection, including the formation of cholecystoenterostomy, characterized in that make the imposition of the anastomosis between the right hepatic duct and the neck of the gall bladder in the region of its bend.



 

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