METHOD FOR DETECTING THE DEGREE OF ACUTE ANASTOMOSITIS OF GASTRODUODENAL ANASTOMOSES

摘要

FIELD: medicine, diagnostics.;SUBSTANCE: it is necessary to evaluate the degree of gastroduodenoanastomosis inflammation after operation in case of its endoscopic type of investigation due to visual evaluation of mucosal surface and the state of sutures in anastomosis area, and carrying out endoscopic ultrasonography of gastroduodenoanastomosis area. Moreover, one should detect the criteria of lesion depth in anastomosis wall by layers and the structure of detected altered part due to successive investigation of all layers of gastric wall, duodenum and adjacent tissues in anastomosis area. In case of signs of growing inflammatory infiltration onto mucosa only at thickening of mucous layer and edema of basement membrane depending upon the degree of edema one should diagnose finishing epithelization of anastomosis area in case of inconsiderably pronounced edema, and at a 2-fold thickening of this mucosal layer as a result of edema - catarrhal (surface) anastomositis. At detecting the growth of inflammatory infiltration onto both mucous and submucous layers at availability of surface defect being not deeper than basement mucous membrane along with thickened mucous and submucous layers and availability of small point or linear hyperechogenic inclusions in mucous and submucous layers one should diagnose catarrhal-erosive anastomositis. At the growth of inflammatory infiltration onto mucous, submucous and muscular layers, impossibility for distinct detection of the borders between these layers, disorders in architectonics of muscular layer one should diagnose infiltrative anastomositis. At addition of ultrasound signs of erosion to the above-mentioned picture in the form of small points or linear hyperechogenic inclusions in mucous and submucous layer, widened vessels in submucous layer and indistinct borders between these layers it is possible to diagnose infiltrative-erosive anastomositis. In case of destroyed integrity of mucous and submucous layers at involvement of muscular membrane as hypoechogenic part of destruction, in the bottom of which one should observe hyperechogenic necrotic masses, development of inflammatory infiltration onto mucous, submucous and muscular layers at affected architectonics of muscular layer and absence of distinct borders between the layers in area of defect one should detect destructive anastomositis. In case of affected integrity of mucous, submucous and muscular layers as hypoechogenic part of destruction at hyperechogenic necrotic masses and availability of defect for the whole thickness of the wall in area of gastroduodenoanastomosis, development of inflammatory infiltration for all layers of anastomosis at developing anastomosis' infiltrate and, also, periprocesses, abscesses associated with the line of anastomosis sutures and beyond external wall of gastroduodenoanastomosis one should diagnose destructive anastomositis complicated with failed anastomosis. The innovation is of high information value, requires no contrast preparations and enables to study layer-by-layer structure of wall in area of gastroduodenoanastomosis. This innovation is very useful to be applied in early postoperational period.;EFFECT: higher accuracy and reliability of detection.;6 dwg, 5 ex