ILEOSIGMOSTOMIYA

From Big Medical Encyclopedia

ILEOSIGMOSTOMIYA (Latin ileum ileal gut + [colon] of sigmoideum sigmoid colon + grech, stoma of companies, opening, pass; synonym: ileosigmoidostomy, ileosigmoidostomy) — operation of imposing of an anastomosis between ileal and sigmoid guts. For the first time And. without crossing of guts the fr. surgeon J. Maisonneuve applied to partial switching off of a colon in 1854 (fig., 1), In 1917 F. Unterberger at acute impassability owing to torsion of a large intestine made And. with addition of a sigmosigmoanastomoz (fig., 2). And. it was applied to unilateral or bilateral switching off of a large intestine at intestinal fistulas and ulcer colitis. At unilateral switching off of a colon crossed terminal department of an ileal gut and anastomosed it with a sigmoid gut (fig., 3). For bilateral switching off of a colon crossed and took in tightly ileal and sigmoid guts, imposed tsekosty for removal a calla and slime and an ileosigmoidostomy (fig., 4).

Fig. Diagrammatic representation of an ileosigmostomiya: 1 — without crossing of a large intestine; 2 — according to Unterberger with addition of a sigmosigmoanastomoz; 3 with unilateral switching off of a colon; 4 — with full switching off of a large intestine: and — a tsekostoma for removal a calla and slime; — an ileal gut; in — a sigmoid gut; — a rectum.

And. it is shown hl. obr. at a polypose of a colon, its divertuculosis, nonspecific ulcer colitis; sometimes at widespread inoperable cancer of a splenic corner of a colon when imposing of a transverzosigmoanastomoz is technically impossible. In these cases And. impose a side sideways. At inflammatory changes of the wall of a gut or at peritonitis And. it is undesirable in connection with threat of insolvency of seams of an anastomosis.

Preoperative preparation includes careful release of a large intestine from contents by use of purgatives and cleansing enemas.

Anesthesia — the intratracheal combined anesthesia.

Quick access — median laparotomy (see). After a subtotal resection of a colon (see. Intestines, operations ) make I. Perevyazav an ileal and colonic artery (a.ileocolica), cross an ileal gut at distance of 15 — 20 cm from a caecum. It is necessary to be convinced of the good blood supply of terminal department of an ileal gut and a stump of a sigmoid gut prepared for an anastomosis. And. it can be carried out by four options: the end in the end, a side in the end, the end sideways, a side sideways. At And. the end in the end is sewed by the guts having various diameters therefore during the imposing of an anastomosis a manual seam it is necessary to cut off the ends them in the slanting direction. This option of an anastomosis can be executed with pomoshchyo a stapler of KTs-28 (see. Staplers ). During the performance And. sideways and a side sideways the ends of a gut it is desirable to take in the end staplers of NZhKA or UKL. During the imposing And. the manual seam applies a two-storeyed seam: the guts taken on clips are sewed serozo-serous noose silk sutures (a back wall of an anastomosis), then put separate noose sutures (or continuous catgut) through all layers of a wall of guts, finish an anastomosis with imposing of separate silk seams on a front wall of an anastomosis (see. Intestinal seam ). The opening between mesenteries of ileal and sigmoid guts is taken in separate noose silk sutures.

In the early postoperative period as a result of insolvency of seams of an anastomosis peritonitis can develop. In later period there can be wearisome ponosa owing to loss of function of a colon.

Late postoperative complications And. there can be a cicatricial narrowing of an anastomosis, disorder of exchange processes as a result of lack of a colon.

Direct and remote results And., and also a lethality are defined by complications of the next postoperative period (see. Peritonitis ) and a current of a basic disease, apropos to-rogo operation it was executed.


Bibliography: Littmann I. Belly surgery, the lane with it., Budapest, 1970; Red A. N. The atlas of operations on direct and thick guts, M., 1968.

G. A. Pokrovsky.

Яндекс.Метрика