METHOD FOR CARRYING OUT THE FIRST STAGE IN TREATING PATIENTS WITH COMBINED STRICTURES OF ESOPHAGUS AND ANTRAL GASTRIC DEPARTMENT

摘要

FIELD: medicine, thoracic surgery.;SUBSTANCE: it is necessary to fulfill superior-median laparotomy, close jejunum V-shapely due to forming enteroenteroanastomosis by "end-to-side" type and withdraw it as a nourishing stoma, form gastroenteroanastomosis. Moreover, at the site of enteroenteroanastomosis formation one should fulfill V-shaped incision at distal part of the intersected small intestine, its sharp angle being towards aboral direction. At incision angles one should apply three sutures-holders through all intestinal layers. The fourth holder should be applied seroso-muscularly in the center between the ends of the incision at the bottom of the valve. The n one should form a double-row anastomosis. The first row of sutures fixes external edge of V-shaped incision and the intersected proximal end of small intestine through all the layers. In area of the fourth holder one should suture the closed jejunum with seroso-muscular sutures by forming enteroenteroanastomosis by "side-in-side" type with posterior gastric wall at the border with the stricture of output department. Moreover, V-shaped incision should be made on the stomach. It is important to for similarly an antireflux valvular gastroenteroanastomosis with anterior gastric wall in fundal area. Below this anastomosis one should apply two transverse sutures through the lumen of small intestine and seroso-muscular gastric layer by providing the obliteration of intestinal lumen. Terminal end of the closed small intestine should be withdrawn as a stoma. The innovation enables to considerably decrease surgical wound, keep physiological passage along digestive tract in area of both narrowing parts and, also, keep the chance for both esophageal bougienage and coloesophagoplasty at the second stage.;EFFECT: higher efficiency of therapy.;1 dwg, 1 ex