METHOD OF PALLIATIVE OPERATION OF PANCREATICODUODENAL TUMOURS

摘要

FIELD: medicine; surgery.;SUBSTANCE: first step includes video laparoscopic cholecystectomy. Stump of cystic duct is separated for the whole length and clipped furthest possible from choledoch. Choledoch lumen is fitted with drainage furnished with loop made of carpon ligature to provide fixation to cystic duct stump. Aperture of drainage diameter is formed on anterolateral wall of choledoch by means of electrocoagulator. Drainage is introduced in aperture lumen in the direction of liver portal and looped with tantalum clip to cystic duct stump. The second step implies laparotomy followed with reduction of mechanical jaundice. Scar cord of drain canal is separated and dissected from anterior abdominal wall. Drainage is changed with rigid suction drain. Proximal end of suction drain is introduced into intrahepatic bile duct and fixed to drain canal. Distal end of suction drain is introduced through gastrostomic aperture into duodenum lumen. Fistulocholedochogastrostomic anastomosis is formed with rigid suction drain introduced to its lumen.;EFFECT: reduced postoperative lethality and provided physiologic biliary excretion and adequate biliation.;5 dwg, 1 ex