COLECTOMY

From Big Medical Encyclopedia

COLECTOMY (Latin colon a colon + grech, ektome cutting, removal) — removal of all departments of a colon — from blind to sigmoid inclusive. In literature this term designate operation more often, at a cut delete all departments of a colon, except a distal part sigmoid. The last is brought to a front abdominal wall in the form of a trailer kolostoma or taken in tightly, leaving a stump in an abdominal cavity or hemming to a peritoneum and an aponeurosis of a front abdominal wall. It is more correct to call such operation a subtotal resection of a colon.

To. make at nonspecific ulcer colitis, a widespread granulomatosis (a disease Krone), at diffusion (family) a polypose of a large intestine, some forms of megacolon and at damages.

Features of preparation to To. are defined not so much by extensiveness of an operative measure, how many weight and character of a current patol, the processes causing indications to surgical treatment. Since at nonspecific ulcer colitis, a disease Krone and diffusion to a polypose usually there are expressed disturbances of exchange processes and an anemia, the main objective of preoperative preparation and postoperative maintaining is the greatest possible correction of these disturbances by intensive transfusion care. Quite often such operations should be carried out quickly (at complications of ulcer colitis perforation or toxic dilatation) and, therefore, only after the minimum training of the patient.

To. it can be successfully executed only in the conditions of the general anesthesia with an effective relaxation of muscles of an abdominal wall. The most rational access is median laparotomy (see). Having made a laparotomy, cut a peritoneum of the left side channel parallel to the outer edge of all descending colon and will gradually mobilize all descending colon by a section of fascial fibers of retroperitoneal cellulose at the shift of a gut of a knutra and kpereda. Then separate a big epiploon from a cross colon throughout and finish with mobilization of a splenic bend. Further the surgeon makes cuts a parietal peritoneum and fibers of a cross fascia of a stomach on the outer edge of terminal department of the ileal, blind and ascending guts, at the same time completing mobilization of a hepatic bend of a large intestine and otslaivy it from a front wall of the descending part of a duodenum. As a result of such preparation of the fabrics surrounding a gut all its departments become mobile and are easily removed in a wound. At the same time there are available to bandaging and crossing main arteries (ileal and colonic, average colonic, lower mesenteric) and the veins accompanying them. The back parietal peritoneum and a mesentery of a cross colon after bandaging of the main vascular trunks are crossed in avascular sites and all colon is deleted after crossing at first of an ileal gut, and then distal department sigmoid colonic or proximal department of a rectum. Operation is finished with imposing or a trailer ileostoma (see. Enterostomy ), or an ileosigmoidny or ileorektalny anastomosis (see. Ileoproctostomy ).

The postoperative current can be complicated by long paresis of the rest went. - kish. path, and also peritonitis as investigation of a basic disease. Besides, development of commissural impassability and other complications is possible. A lethality after operation K. it is considerable. In this regard To. is the operation performed only according to vital indications.

See also Intestines .


Bibliography: Rivkin V. L., etc. Polyps and diffusion polyposes of direct and thick guts, M., 1969, bibliogr.; Yudin I. Yu. Surgical treatment of nonspecific ulcer colitis, M., 1976; Yu x - in and d about in and Zh. M. and Levitan M. of X. Nonspecific ulcer colitis, M. 1969, bibliogr.


V. D. Fedorov.

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