GASTROYEYUNOPLASTIKA

From Big Medical Encyclopedia

GASTROYEYUNOPLASTIKA (Greek gaster stomach + lat. jejunum a jejunum + grech, plastike sculpture, plastics) — a technique of unwinding of a resection of a stomach or a gastrectomy formation of an additional tank from a piece of a jejunum between a stump of a stomach (or abdominal department of a gullet) and a duodenum. The parts of the patients who transferred the resection of a stomach, digestive disturbances connected with disturbance of reservoir function of a stomach as a result of removal of its considerable part and switching off of a passage of food masses on a duodenum taking place at a nek-swarm were the cause for development of similar operations.

the Scheme of a gastroyeyunoplastika across Kupriyanov — to Zakharov: a continuity of a gut in the place of the taken transplant recover an anastomosis the end in the end, and move the mobilized segment of a jejunum on a vascular leg through a window in mesocolon to the upper floor of an abdominal cavity and in the isoperistaltic direction anastomose at a gastrectomy with a gullet (a), at a resection of a stomach from stumps of a stomach (b) and with a duodenum the end in the end (1 — a diaphragm; 2 — a transplant; 3 — a duodenum; 4 — the line of an anastomosis on a small bowel after cutting out of a transplant; 5 — the sewn-up opening of a mesentery of a cross colon; 6 — a stump of a stomach).

In 1924 P. A. Kupriyanov published the method of plastic substitution of the peloric department of a stomach deleted at a resection developed by it on corpses a piece of a jejunum on a vascular leg, anastomozirovanny in the isoperistaltic direction from stumps of a stomach and a duodenum. In 1926 this principle was used by A. Balog for creation of a relay tank between a gullet and a duodenum at a gastrectomy. Implementation in clinical practice of these operations was promoted by works of E. I. Zakharov who for the first time in 1938 applied in G.'s clinic by the technique developed by P. A. Kupriyanov. In post-war years he repeatedly made the clinical and experimental data confirming a number of advantages of this operation that drew attention of many surgeons (A. A. Busalov, G. D. Vilyavin, Yu. T. Komarovsky, B. S. Rozanov, I. L. Rotkov, etc.). By this time there was a number of works of foreign authors with favorable assessment of G. and with the description of separate details of the technology of this operation [Bidl (M. of Biedl), 1947; F. Henley, from 1952 to 1955; Hepp (J. Nerr), 1958; Nakayama (To. Nakayama), 1956; A. Papke, 1956, etc.].

Technology of operation

the Piece of a jejunum of 10 — 15 cm (at gastrectomies — to 20 cm) on a vascular leg is found from its initial loop. A continuity of a gut in the place of the taken transplant recover an anastomosis the end in the end, and move the mobilized segment of a jejunum on a vascular leg through a window in mesocolon to the upper floor of an abdominal cavity and in the isoperistaltic direction anastomose (in the form of an intermediate insert) from stumps of a stomach (fig.) (or with a gullet — at gastrectomies) and with a duodenum the end in the end. The window in a mesentery of a cross colon is taken in. As reconstructive operation G. is made at patients with heavy postresection disturbances of digestion. Recovery of a passage of food masses through a duodenum (a so-called reduodenization) contributes to normalization of rate of intake of digestive juices in a gut, improves secretory function of the main digestive glands.

Indications to secondary G.: 1) the disturbances of digestion expressed, not giving in to conservative treatment with decline of food and the accompanying painful phenomena after a resection of a stomach; 2) after gastrectomies and extremely subtotal resections of a stomach which always are followed by decline of food and the expressed disturbances of digestion. Primary gastroduodenoyeyunoplastika is applied seldom, according to special indications in specialized institutions. In broad practice it is recommended to apply the standard methods of a resection of a stomach (see. Billroth operation ).

See also Gastrectomy , Stomach , operations.


Bibliography: Berezov Yu. E. and Warsaw Yu. V. Operirovannny stomach, M., 1974, bibliogr.; In and l I - wines G. D. and Berdov B. A. Diseases of the operated stomach, page 261, M., 1975, bibliogr.; Zakharov E. I. and Zakharova.E. Enteric plastics at gastrectomies and a resection of a stomach, M., 1962; Kupriyanov P. A. Plastics of a peloric part of a stomach by means of a small bowel, It is new. hir. arkh., t. 6, No. 1, page 49, 1924; In and 1 about g A. Bildung eines Ersatzmagens bei der volligen Magen-entfernung, Zbl. Chir., S. 2581, 1926.

B. S. Rozanov.

Яндекс.Метрика