SHEVASSYU-GREGUARA OPERATION

From Big Medical Encyclopedia

ShEVASSYu - GRÉGOIRE OPERATION (M. of Chevassu, the fr. surgeon-urologist, 1877 — 1957; W. Gregoire, sovr. the Belgian surgeon) — operation of removal of retroperitoneal cellulose and the lymph nodes located in it; it is applied at malignant tumors of a small egg.

M. Shevassyu in 1906 and irrespective of it by Gre-guar in 1914 is for the first time executed. Operation is shown at ge.rminogenny tumors of a small egg (see), except for a seminoma (see) and horionepitelioma (see. Trophoblastic disease), after a shouting-hofunikulektomii and careful gistol. researches of a remote small egg. Due to the great difficulties of recognition of retroperitoneal metastasises operation is made even in the absence of data on regional innidiation. Thanks to achievements of chemotherapy of tumors (see) there was an opportunity to carry out operation at the remote metastasises and big regional tumoral conglomerates after treatment by antineoplastic means. Technology of operation in recent years repeatedly changed, innovations concerned generally accesses to regional limf, nodes and the volume of intervention. In a crust, time most of surgeons make a transabdominal bilateral limfadenektomiya. Its advantages before extra peritoneums-nymi by methods consist in a possibility of audit of abdominal organs and simultaneous removal limf, nodes and the cellulose surrounding a belly part of an aorta and the lower vena cava.

Operation is carried out under anesthetic (see). The abdominal cavity is opened with midsection from a xiphoidal shoot of a breast to a pubic symphysis (see the Laparotomy). The small bowel is stacked on an abdominal wall in the towel moistened with warm physiological solution. The cross colon is stacked in an upper corner of a wound. The parietal peritoneum is cut between a belly part of an aorta and the lower vena cava above to the level of renal vessels, below to the cape and over ileal vessels. The peritoneum and a part of a duodenum will be mobilized then bare retroperitoneal space (see). Delete with the uniform block limf, nodes and the cellulose surrounding a belly part of an aorta and the lower vena cava from renal vessels to outside ileal arteries. If necessary tie up the lower mesenteric artery. In case of an arrangement of a metastasis in the field of gate of a right kidney access to it is complicated. In such cases the parietal peritoneum is cut from the cape along the blind and ascending colon up the lateral channel then will mobilize a large intestine, as a result access to a right kidney is considerably facilitated. Operation is finished with sewing up of a parietal peritoneum and a wound of a front abdominal wall. If necessary leave an extra peritoneal drainage.

384 ShEVKUNENKO


Bibliography:

Care for Marinbakh E. B. Opu a small egg and its appendage, page 125, etc., M., 1972; The Reference book on urology, under the editorship of N. A. Lopatkin, page 269, M., 1978; Chevassu M. Tumeurs du testicule, P., 1906. B. P. Matveev.

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