GEMIKORPOREKTOMIYA

From Big Medical Encyclopedia

GEMIKORPOREKTOMIYA (Greek hemi-to a floor + lat. corpus, corpor[is] body + Greek ektome cutting, excision; synonym translyumbarny amputation) — operation of removal of both lower extremities together with a basin and its bodies.

Operation was for the first time executed by Kennedy (G. S. Kennedy, 1960); the patient died for the 11th days after operation from a fluid lungs. The first successful operation was executed by Aust (J. Century of Aust) in 1961 concerning the planocellular cancer which developed from decubitus in the field of a sacrum and burgeoning in bodies of a small pelvis.

The modern equipment G. is developed by Miller (T. R. Miller, 1966) who has the greatest experience in performance of similar operative measures. During the definition of indications it is necessary to consider possibilities of rehabilitation and a nosotrophy after such mutilating operation.

Medical indications to G.'s performance (in case of lack of effect of other standard methods of treatment) are the following diseases: malignant tumors of pelvic bones, bodies and soft tissues of a small pelvis, tending to remain locally widespread process for a long time.

The house of a sacrum, cancer of a bladder, cancer of a vagina, neck of uterus and a carcinoma cutaneum with germination in bodies of a small pelvis were made concerning chondrosarcomas of pelvic bones with germination in sacroiliac joints, chorus.

Due to the weight and duration of an operative measure of the patient physical shall have good the general. state.

Operation can be executed one - or dvukhmomentno. Due to duration of an operative measure (the first operation continued 13,5 hours) two-stage operation is more often applied.

The first stage — intraperitoneal — consists in removal of urine and a calla. After the lower median laparotomy the surgeon first of all is convinced of lack of metastasises in abdominal organs. Then, if vessels of a mesentery allow, make change of ureters in the segment found from distal department of a sigmoid gut which is brought in the form of an ostomy to a front abdominal wall of a navel on the right and above. The proximal end of a sigmoid gut is removed in the form of a single-barreled anus of a navel at the left and above (see. Anus praeternaturalis ). The distal end of a sigmoid gut and the proximal end of a rectum after a section sew up tightly and immerse in a small pelvis; the pelvic peritoneum is recovered. If blood supply does not allow, ureters are replaced in the isolated segment from a small bowel. In 10 — 14 days when the condition of the patient becomes satisfactory, the second phase — Extra peritoneal is completed. Position of the patient — on spin. The semi-oval section going from one anterosuperior awn of an ileal bone to another parallel to pupartovy sheaves and a pubis bare a peritoneum. The peritoneal bag is displaced up to the level of renal vessels, beginning from which removal paraortalny limf, vessels is made. After that allocate the general ileal arteries and take on ligatures, but do not tie up. Then allocate the lower vena cava and under it also bring ligatures. Before operation enter a catheter through one of saphenas of a hand for measurement of the central venous pressure into an upper vena cava. The general ileal arteries tie up and transfer the patient to the provision of Trendelenburga until the central venous pressure does not rise to 130 mm w.g. or will remain stable within 3 min. The lower vena cava is tied up and 3 vessels cross all. Cross both lumbar muscles and stumps of vessels displace up, bare lumbar department of a backbone. The partition of a backbone is made at the level V, IV or III of lumbar vertebrae. In order to avoid damage of a firm meninx removal of a body of one of vertebrae and opening of the spinal channel make an oseotome. The bag from a firm meninx is allocated together with a horse tail, tied up and crossed. The patient is overturned on a stomach. Cross a fascia and a muscle of a back, delete a lower body. Make layer-by-layer sewing up of a wound with leaving of a drainage in corners of a wound.

The deleted part of a body makes about 45% of body weight (from 40,4 to 52%) in this connection both in time, and after operation there are difficult questions of preservation of a homeostasis. Modern opportunities of anesthesiology and resuscitation reduced operational risk to a minimum. Exact figures of a lethality after a gemikorporektomiya are not known since in literature only separate cases of similar operations are published. The greatest number G. is made by Miller — 6 operations without lethal outcomes. After recovery of the patient there are complex problems of rehabilitation connected with difficulties of prosthetics and movement. There are single patients who lived after similar operations more than 5 years.



Bibliography: Garbau M. a. Alexandre J. H. Technique de 1'amputati on translombaire, J. Ghir. (Paris), t. 101, p. 389, 1971; MillerT. R., MacKen-zie A. R. a. Karasewich E. G. Translumbar amputation for carcinoma of the vagina, Arch. Surg., v. 93, p. 502, 1966.

H. H. Trapeznikov.

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