METHOD FOR PANCREATODUODENAL RESECTION AT LOCALLY-METASTASING CANCER OF PERIAMPULLAR AREA AT VAST TUMOR INVASION OF THE MAIN VEINS OF MESENTERICO-PORTAL SYSTEM AND THE PRESENCE OF TWO MAIN TRUNKS OF THE SUPERIOR MESENTERIC VEIN

摘要

FIELD: medicine, surgery.;SUBSTANCE: it is necessary to fulfill circular resection of the main trunks of the superior mesenteric vein as a single block with pancreatoduodenal complex, portal and splenic veins, fulfill the reconstruction of the main veins of mesenterico-portal system, fulfill the reconstruction of digestive tract. Moreover, one should form a terminal anastomosis between left-handed trunk of the superior mesenteric vein and autovenous or synthetic conduit. One should form anastomosis between conduit and the stump of portal vein, apply conduit at the excess of length being one third against the length of direct defect between maximally adjacent stumps of left-handed trunk of the superior mesenteric and portal veins. On reconstructing the main portal circulation it is important to fulfill the conduit implantation of right-handed trunk of the superior mesenteric vein under conditions of lateral conduit's squeezing out followed by spleno-portal prosthetics with autovenous or synthetic conduit at implanting the latter into the side of portal vein or pre-formed mesenterico-portal prosthesis under conditions of lateral squeezing out. The innovation enables to carry out adequate multi-purpose venous reconstruction of mesenterico-portal system after vast resection in case of two main trunks of the superior mesenteric vein.;EFFECT: higher efficiency.;4 dwg, 1 ex