| 摘要 |
FIELD: medicine; abdominal surgery. SUBSTANCE: patient is subjected to median laparotomy. After eliminating infection source, abdominal cavity is washed with 5-6 liters of antiseptic solution. If there is defect in small intestine, it is temporarily sutured, followed by measuring intestine length from Treitz ligament up to destructively altered intestine segment. When intestine length is at least 1.8 m, loop-shaped double-way ileostoma is applied. Enterostomic window is formed in right mesogastral region, followed by careful hemostasis. Next parietal peritoneum is attached by suturing to aponeurosis with help of 4-6 sutures equidistantly spaced apart, while ends of ligatures are retained by holders. Fistula-affected intestinal loop is isoperistaltically withdrawn onto anterior peritoneal wall. Alloplant is introduced through window formed in mesentery in front of intestinal wall defect, followed by fixing alloplant on both sides from stoma to aponeurosis by individual sutures. Mesenterial peritoneum is finally fixed on both sides of stoma by pre-applied sutures and tied up, thread ends are cut short to form first row of sutures, above which, between skin and mesenterial peritoneum, second row of sutures is applied. Next temporary sutures are taken off intestinal wall, while defect in intestinal wall is extended in transverse direction to form so-called "spur". During subsequent 3-4 weeks mucosa of stoma is turned inside out and joins skin by inoculation. EFFECT: method permits to prevent aquo-electrolytic balance disturbances by applying ileostoma at exact point located by measuring maximum permissible small intestine length. |
