Drainage for the formation of the anastomosis biliodigestive
The invention relates to surgery and can be used to form biliodigestive anastomoses with the "lost" drainage. Drainage is designed as two single-channel tube of synthetic plastic material with ends in the form of mushroom-shaped extensions. The total lumen of the drainage does not exceed physiological lumen of the choledochus. The distance between the mushroom-shaped extensions corresponds to the thickness of the walls anastomosing bodies and is 1.5-2.0, see the reach of creating a "lost" drainage for forming biliodigestive anastomosis, which provides reliable fixation of the latter in the place of anastomosis and reduces the risk of obstruction. 1 C.p. f-crystals, 4 Il. The invention relates to medicine, namely to surgery, and can be used to form biliodigestive anastomoses with the "lost" drainage.There are various types of drains for the formation of such anastomoses. Known drainage for forming an anastomosis in the form odnoprovodnoi hollow tube with perforations at its ends (E. C. Smirnov. Surgical operation on the biliary tract, Medgiz, 1961, S. 103-113). However, the disadvantage of these drainages is enabled, the different ways the proposed device drainage with "mushroom" extension on both ends (internal biliari drainag - "double mushroom" a COOK GROUP COMPANY, DK-4632 Bjaeverskov, LOT 941423), but it is bulky due to the fact that lengthened the distance between the "mushroom-shaped" extensions, and this in turn promotes the migration of drainage. In addition, the drainage has only a single lumen, causing a high probability of its obturation food masses, flakes of fibrin, crystals of bile acids.The objective of the invention is the creation of "lost" drainage for forming biliodigestive anastomosis, which provides reliable fixation of the latter in the place of anastomosis and reduces the risk of obstruction.The problem is solved in that the drainage consists of two single-channel silicone tubes, the ends of which are made in the form of a "mushroom" extension, and the distance between them is 1.5-2 cm, which corresponds to the thickness of the walls anastomosing bodies.The device is made with two openings due to the fact that with only a single lumen drainage there is a greater likelihood of obstruction of its lumen of the food mass, flakes of fibrin, crystals of bile acids. If there are three gaps design becomes cumbersome in addition, lonie ducts, connection cholangitis. Therefore, the total clearance of drainage must not exceed physiological lumen of the choledochus (7-9 mm).The essence of the claimed device is illustrated by a drawing.In Fig. 1, 2 shows a longitudinal cross section of the drain of Fig.3 is a cross section of the drain of Fig.4 - standing drainage in place imposed anastomosis.The drainage consists of two odnoproletny silikonovyh tubes 1 and 2. The ends of the tubes are made in the form of a "mushroom" extension 3. The distance between the "mushroom" extension is 1.5-2 cm, which corresponds to the thickness of the walls anastomosing bodies.The claimed device operates as follows. On the wall of the gallbladder impose a purse string suture diameter, for example, 20 mm in the center of which make a puncture incision is long, for example, 5 mm, then impose a purse string suture in the wall of the stomach, retreating from puncture-section, for example, 5 mm in diameter, for example, 20 mm, make a puncture incision is long, for example, 5 mm inside the purse-string suture. One end of the drainage 1 with "mushroom" extension 3 is introduced into the lumen of the gallbladder, and the other is injected into the lumen of the stomach, after which the purse string sutures are tightened and tied, and between the walls of the gallbladder and stomach impose individual nodes>/p>Patient W., 66 years old, was admitted after 7 days of onset. Diagnosis: pancreatic cancer complicated by compression of the distal choledochus, mechanical jaundice. The patient held conservative therapy, examination, and to eliminate hyperbilirubinemia performed percutaneous perhepatic the cholangiography, at the same time found the tumor obstruction of the distal choledochus. Cholangioscopy drainage to spend in the 12-duodenum through the obturation could not, therefore, fulfilled the outer hepaticotomy. However, the outer hepaticotomy impairs quality of life, causing discomfort in the place of standing drainage, leads to the loss of bile out. To eliminate the drawbacks of external drainage, the patient completed: from mini-access (the length of the incision in the right upper quadrant was 6 cm) formed biliodigestive anastomosis on the developed drainage. The postoperative period was uneventful, the patient began to stand up and walk to the end of the first day after surgery. Pain in the postoperative wounds with a 3-day passed. After 3 days the patient spent-control study - dynamic cholescintigraphy on which the passage of the radiopharmaceutical in the intestine in full fighting stopped. The patient was discharged from hospital on the 7th day in a satisfactory condition.Thus, the use of the proposed drainage for the formation of biliodigestive anastomosis allows him to avoid migration and reduce the risk of obstruction of its lumen.
Claims1. Drainage for the formation of biliodigestive anastomosis of synthetic plastic material with ends in the form of mushroom-shaped extensions, characterized in that it is made of two single-channel tubing and has a total clearance, which does not exceed physiological lumen of the choledochus, the distance between the mushroom-shaped extensions corresponds to the thickness of the walls anastomosing bodies and is 1.5-2.0 see2. Drainage under item 1, characterized in that it has a total clearance 7-9 mm.
FIELD: medicine; medical engineering.
SUBSTANCE: method involves creating central end-to-end anastomosis of blood vessel and synthetic prosthesis. Porous titanium nickelide device of 50-65% porosity and pore size of 50-200 mcm, is conducted through peripheral vascular prosthesis end. The cylindrical device is not shorter as 25 mm and has longitudinal slit. The device is set in a way that the slit and anastomosis line are overlapped with the cylinder at distance not shorter than by 5 mm and aorta segment adjacent to the prosthesis at 25 mm long distance. The longitudinal slit is arranged on blood vessel wall with slightest deviation and fixed on both sides with 2-3 sutures.
EFFECT: accelerated operation time; reduced risk of traumatic complications.
2 cl, 2 dwg