РЕКОНСТРУКЦИЯ ПИЩЕВАРИТЕЛЬНОГО ТРАКТА ПРИ РАСПРОСТРАНЁННОМ РАКЕ ЖЕЛУДКА ПОСЛЕ ГАСТРЭКТОМИИ С ФОРМИРОВАНИЕМ ИСКУССТВЕННОГО РЕЗЕРВУАРА ПО ГОФМАНУ

摘要

The article contains the results of the first clinical experience of application of original method of surgical treatment of stomach cancer by performing a gastrectomy and formation of artificial jejunum reservoir. The relevance of the study consists in the imposition of a submerged organ of the esophageal-jejunal anastomosis hanging down the lumen of the organ, anastomosing the stump of the pancreas with the jejunum by "end-to-side" type, with a mucosal mucosa seam with a sleeve-shaped anastomosis peritoneisation and a lean jejunum loop at the level of the choledochus stump - creating anti-reflux "end-to-side" choledochojejunoanastomosis, followed by the formation of Braun anastomosis with 20 cm reservoir, by Hoffman's stomach type, performing a function of the removed stomach. The method proposed by the authors of the present study is based on more than 15years of practice in the use of refluxing anastomoses in trans-abdominal surgery and 70-year-old practice of applying diaphragm crurotomy by A.G. Savinykh, as the only method of access to the esophagus. The treatment results were assessed using X-ray contrast techniques, endoscopic and ultrasound equipment, as well as traditional laboratory, radiographic and clinical tests. The results of treatment of 6 patients in terms from 6 months to 5years were estimated. Successful outcome of the surgery was achieved in all cases. The effectiveness of the intervention is confirmed throughout the range of clinical and instrumental criteria used. The authors conclude that the method shows a good clinical perspective.