| 摘要 |
FIELD: medicine. ^ SUBSTANCE: invention relates to medicine, surgery. After dissection and sewing of externall duodenal fistula, shutting off of duodenum is carried out. Treitz ligament is transected. Indenting 40 cm from Treitz ligament, first part of small intestine is taken and transected. Proximal part of intestine is freed from mesentery, preserving blood supply of its wall on 3 cm. Two lateral traction sutures are applied. Indenting 3-4 cm from borders of mesentery-free part of small intestine, longitudinal 2 cm long cut of small intestine wall is performed on counter-mesentery surface. Two traction sutures are applied on wound edges. Walls of formed wound are moved apart by means of earlier applied two traction sutures. Through enterotomy wound by means of forceps traction sutures of mesentery-free part are gripped and its invagination into intestine lumen to distal edge of enterotomy wound is carried out. By means of interrupted suture through all layers of intestine wall counter-mesentery surface of invaginated part is sewn with distal edge of enterotomy wound. Areflux valve is formed due to fitting of loosely hanging into intestine lumen counter-mesentery edge. Proximal part is brought out 10 cm lower than edge of left rib arch on anterior axillary line through separate cut. Distal part of small intestine is used for formation of Roux gastroenteroanastomosis. After that inter-intestinal entero-enteroanastomosis is applied between first part of small intestine, indenting 15 cm from transected Treitz ligament, and small intestine loop, used for gastroenteroanastomosis, 20 cm lower than latter. Into duodenum through jejunostome to stump cupula passed is chlorovinyl tube with diametre 0.5 cm with lateral perforation holes with diametre 0.3 cm, located on its distal part in duodenum lumen for carrying out duodenal decompression. ^ EFFECT: method ensures full-fledged decompression of duodenum, early enteral feeding in post-operation period; reduces risk of duodenal fistula recurrence and various purulent complications, does not require special equipment and tools; is simple in operative implementation. ^ 1 dwg, 1 ex |
