Surgical method for treating the cases of right colon half cancer

FIELD: medicine.

SUBSTANCE: method involves mobilizing the duodenum after having stated tumor resectability. Retrocaval, laterocaval, precaval, interaortic, preaortic lymphatic viae are dissected. The removable region and intramesenteric lymph collector are immobilized with additional iliocolic and middle colic artery ligation and skeletonization of a. mesemterica superior and right ureter. Retroperitoneal cellular tissue is withdrawn within the limits of right lumbar muscle. The preparation is excised in doing right-side hemicolonectomy.

EFFECT: enhanced effectiveness of treatment; radically removed tumor dissemination collectors.

 

The invention relates to medicine, in particular to cancer, and is intended for the treatment of patients with cancer of the gastrointestinal tract.

There is a method of surgical treatment of cancer of the right colon - right hemicolectomy, including laparotomy, revision, opening the right side of the channel, determining resectability, the mobilization of the removed part of intestine with vnutribryushnymi lymphosarcoma with ligation of the major vessels - ileocolica, colica dextra, the cutoff of the drug, the formation of the anastomosis, drainage, restore the integrity of the peritoneal suturing of the wound (1, 2).

The disadvantage of this method is that it is not removed lumbar reservoir regional metastasis, which does not allow to reach the maximum radical surgery, and, consequently, reduces the effectiveness of treatment of patients with cancer of the right colon cancer.

The aim of the invention is to improve the effectiveness of treatment of patients with cancer of the right colon cancer.

This goal is achieved by the fact that after opening the right side of the channel and determine the resectability of the tumor produce the mobilization of the duodenum by Kocher, providing access to the lumbar collector lymphogenous metastasis, then do dissectio retrocam is high, lateraling, pregabalina, interarticular and preostalog lipoprotein ways; then produce the mobilization of the removed part of intestine with vnutribryushnymi lymphosarcoma with ligation of major vessels (ileocolica, colica dextra, colica media), with skeletization a. mesenterica superior, right ureter, removal of retroperitoneal tissue within the right psoas muscle, then carry out the final phase of the operation.

The method is implemented as follows: perform laparotomy, revision, open the right side channel of the abdominal cavity and determine the resectability of the process, mobilize the duodenum by Kocher, perform the dissection retrochallenge, laterobasal, pregabalina, interarticular and preostalog lipoprotein ways to mobilise the deleted part of intestine with vnutribryushnymi lymphosarcoma, with ligation of major vessels (ileocolica, colica dextra, colica media), with skeletization a. mesenterica superior and right ureter, removal of retroperitoneal tissue within the right psoas muscle, cut off the drug, form the anastomosis, drain the abdominal cavity, the surgical wound is sutured.

Clinical example.

Patient S., aged 63, was admitted to 4 surgical Department of the Samara oblast Oncology dispensary with a diagnosis of Cancer of the rising of the Department of the colon kick is. After preoperative preparation patients received surgical treatment. During the revision, the tumor of the rising of the Department of colon 7×5 cm, determined enlarged, condensed vnutribryushnye lymph nodes of the 1-St and 2-nd order in the lumbar lymph nodes of lymphosarcoma clinically metastatic lesions not identified. The patient underwent extended right-sided hemicolectomy by the proposed method. Histological examination of the removed medication identified saucer-like shape moderately differentiated adenocarcinoma with a diameter of 5 cm, metastatic lesion of the four lymph nodes vnutribryushnogo of lymphosarcoma, and revealed metastasis in one pregabalina lymph node, not identified in the operations clinically. The postoperative period was uneventful. The patient was discharged on the 14th postoperative day in good condition. In the future, patients received 3 courses of chemotherapy. At follow-up the patient after 1 year and 5 months after surgery signs of progression, distant anaesthesia and locoregional anaesthesia metastasis was not detected. The patient socially adapted.

Using the proposed method allows to obtain the following positive effects: dissection of the lumbar lymphatic collector obespechivayutsya last stage lymphogenous metastasis up to the confluence of the thoracic lymphatic duct. Resulting in the execution of the extended right-hand hemicolectomy removes all regional collectors lymphogenous metastasis of cancer of the right colon cancer. This allows you to achieve maximum Oncology radical surgery. In turn, this provides an improvement of the surgical treatment of patients with cancer of the right colon cancer, increases the duration of their lives.

Way possible and appropriate to use in surgical Oncology departments of hospitals in surgical treatment of cancer of the right colon cancer for maximum oncological radical surgical treatment in terms of improving the efficiency of treatment of patients with cancer of the right colon cancer.

Sources of information

1. Illichmann. Abdominal surgery. Budapest, 1970, s-315.

2. Beilenson, Whichelow, Aeacs. Atlas of cancer operations. M.: Medicine, 1987, s-371.

Method of surgical treatment of cancer of the right colon cancer by the right-hand hemicolectomy, including laparotomy, revision, opening the right side of the channel, determining resectability, the mobilization of the removed part of intestine with vnutribryushnymi lymphosarcoma with ligation of the iliac-colon-intestinal artery, protobalanus artery, clipping of the drug, the formation of the anastomosis, drainage, restore the integrity of the peritoneal suturing of the wound, wherein after determining the resectability perform the mobilization of the duodenum by Kocher, dissection retrochallenge, laterobasal, pregabalina, interacting and preostalog lipoprotein ways, perform the mobilization of the removed segment of the colon with vnutribryushnymi lymphosarcoma with additional ligation of the middle colon artery with skeletization a. mesenterica superior, the right ureter with the removal of retroperitoneal tissue within the right psoas muscle, then carry out the final phase of the operation.



 

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