great omentum viddileny vid colon and at the same time with the slurry up the hill. The shaded area is guilty of buty resection. The right to the shlunkovy-omental artery needs to be tied up closer to the collar - 1. It is necessary to apply the qiu ligature even more carefully, so that you do not allow it to suffer.

On the baby, the images are bandaged right shlunkovo-glandular, right shlunkovy and shlunkovo-two-fingered bowel, two-fingered bowel was converted to 2 cm from the gate. The distal segment of the duodenal gut is buried with the Duval forceps. On the end of the proximal segment of the duodenal gut, carefully put two naval sutures, so that you will not damage your blood supply, as it is necessary to preserve the anastomosis for further successful completion of the anastomosis. The blood posture of the th small segment of the twelve-fingered intestine may lie as much as intramural circulation through the vintsev or liva shlunkovu and liva shlunkovo-omental artery. It is necessary to remember that the first 3 cm of the twelve-fingered intestine is carried to the cybulin, which is otched out by a queue, vilna and crumbling, at that time, as distant, or "postbulbar", a segment of the lateral attachments of the back

Overwhelming blood-bearing judges in case of pancreatoduodenal resection due to the collar's safety, the surgeon is guilty of memory about the number of variants of blood loss of the twelve-fingered intestine, in order to preserve the blood loss adequately and in such a way. On the whole and on the onset of the little ones, the visualization of the arterial blood supply of the upper horizontal part of the twelve-fingered intestine is shown. This baby shows the blood loss of the upper horizontal part of the duodenal intestine from the pyloric, or the right slunk, artery, and from the backward hepatic artery - 1, from the supraduodenal retinal artery, which goes through the artery slunk-stuffing box artery - 3.

In this vipadku bloodletting of the upper horizontal part two-fingered intestines to work from the pyloric, or right-to-right, arteries, from the supraduodenal artery - 1, from the supraduodenal artery, how to walk from the two-way arteries - 2 arteries

Bloodletting of the upper horizontal part two-fingered intestines. Piloric artery, as you can bachiti on a baby, vinikas from pechinkovo ​​artery - 1, supraduodenal artery to be seen from two to twelve-fingered arteries - 2, other retroduodenal arteries - 3 shlunkovo-salnikove - 4 and the upper-posterior bottom-two-tier arteries - 5.

In the first place it is piloric (shlunkov's rights) artery view from the backward pechinkovo ​​artery - 1, the supraduodenal artery from the day, and from the backward artery, from the pyloric artery -2; shlunkovo-dvadtsyatipala - 3 і rights shlunkovo-salnikove -4 arteries.

pancreatoduodenal resection completed. In this context, the secret of the pancreatic-skinny anastomosis by the method of innovation is described for the classic pancreatoduodenal resection. The pancreatic secret is introduced to the name of the additional strength of the tube. At 15-20 cm distal pechin-jejunal anastomosis of a small duodenal bowel anastomosed with a thin intestine by a noble suture. For the stem of a furnace-free anastomosis, it is necessary to have a sufficient blood supply to the duodenal bowel. It is also important to avoid getting into the collar seam, so that you can get rid of the problems with getting the slider in during the operational period... The shank and the seam material are guilty of being thin, so it is necessary to make the oper- ational embryo to a minimum. For decompression of the slunk by hand, a gastrostomy, a foley catheter, replace the Levine probe, and some of the decompression of the slunk can be used for a term of up to 2 or more.

In the given vypad the channel of the slurry buv anastomosed with the mucous membrane of the small intestine ("mucous to mucous"), the same technique was used as during the classical operation. Tsei anastomosis can be seen only with significantly expanded pancreatic prototypes with vigorous scars. Інші anastomoses are similar to anastomosis, images on the anterior little one.

In this case, anastomosis kuksi pidshlunkovoy zalozi viconano shlakhom її implantation in the back wall of the shlunk. Yak і in classic surgery, pidshlunkovu zloza can be anastomosed from the thin intestine, or by the slunk by the implantation method, or by imposing anastomosis between the mucous membrane of the pancreatic duct and the mucous membrane of the posterior mucosa. Anastomosis of the kuksi duct of the bottom slurry and the bottom of the slurry can be shown with a single-row seam, the position of the slunk, or with a noble suture, applying one row of seams for the slurry, and the middle one. Vibir of the optimal operating technique to lay down in the surroundings. If a different row of seams is placed in the middle of the shlunk, then it can be applied only through the opening of the anterior wall of the shlunk;

Re-scaled the surface of the bottom hole Suture the slurry to the serous-oily ball with non-absorbable sutures. Then, in the stage of the slunk, there is a small rise, due to the diameter of the pancreatic duct, which is to blame for being significantly enlarged, for this purpose it is possible to form an anastomosis. If the pancreatic zalosis is pushed up to the shlunk, the pancreatic protrusion is anastomosed from the shlunka with non-absorbable sutures - 1, for which a flexible catheter is inserted into the duct. Then the anastomosis of the ducts is completed - 2. When the anastomosis is formed, it is necessary to use a magnifying glass. Anastomosis is completed on the surface of the mucus from the bottom of the slurry to the serous ball of the slunk from the protylny side - 3.

The qia technique is even similar to that described for the classic operations... Surgery for Traverso-Longmire does not include the resection of the slunk, for the internal part of the anastomosis of the anastomosis of the anastomosis of the anterior wall of the slunk up to 8-10 cm. 2 - Anastomosis of the pancreatic duct from the wall of the shlunk ("mucus to mucous"), 3 - Completions of the anastomosis from the silt tube, called through the anterior wall of the shlunk.

- Turn into zm_st rozdila " "

Pancreatoduodenal resection is the only radical method for treating cancer of the head of the pancreatic cavity, the preampular part of the posterior zhazhny duct and the great nipple of the duodenum.

Operation of a clearing in the resection of the head of the gut and two-fingered intestine with further renewal of the passage of the intestinal tract and the gut. Oscillations of the technique of pancreatoduodenal resection are arched foldable, proponated richly new options operations, which are based on methods of applying anastomosis between the gut ducts and the intestinal tract, as well as the technique of processing the mucous membrane.

All methods of pancreatoduodenal resection V. N. Shamov podilayє on chotiri group.

Before the first group, there should be methods that are characterized by the imposition of anastomosis between the gum and the slurry and the insertion of the mucus into the small intestine (Fig. 693).

693. Scheme of pancreatoduodenal resection. I option.

Another group of common methods, when you impose an anastomosis between the gallbladder duct and the small intestine; stitch the stump into the small intestine (Fig. 694).

694. Scheme of pancreatoduodenal resection. II option.

The third group is characterized by overlapping cholecystojejunostomy with sutures of kuksi pidshlunkovoy zalozi tightly or extirpating (Fig. 695).

695. Scheme of pancreatoduodenal resection. III option.

For the fourth group, it is characteristic є the overlaying of the back through the gallbladder duct and the small intestine from the close-ups of the kuksi pidshlunkovoy zalozi tightly abo visible її (Fig. 696).

696. Scheme of pancreatoduodenal resection. IV option.

It is important for the result of the operation - the rational expansion of the anastomoses between the chewing gates, the coughs, the slurry and the intestines. Most often, the most high anastomosis is made between the gut and the intestine, the lower trochus is the anastomosis of the mucus to the bottom of the intestine and the lower is the gastroenteroanastomosis.

Operation technology. Cherevnu emptied by means of transverse razrіz. If necessary, you can carry out additional development along the middle line.

gossip black empty vibrate the mobilization of the two-fingered intestine and the head of the lump. For a large number of intestines from two to twenty-fingered intestines, parietal necks are dissected and the intestine is stupidly exfoliated at once from the head of the adolescent gullet from the pedunculated veins and the lower empty veins (Fig. 697, 697). The scalding of the front surface of the slurry head is repaired from the partial overflow of the gland and the slurry-rim joint, which is tied with the right to the slurry-stuffing box artery. The breeches of the transverse rim intestine extend to the bottom, and the shlunks - burn down, release the parietal gullets and release the breeches from the head and the hook-shaped appendage of the sublunculus (Fig. 699). We can move the veneer part of the slurry along the small curvature, rewire and overtake the right slunker and the slurry-two-twelve-fingered artery, which replaces the bottom of the two-fingered gut and the head

697. Pancreatoduodenal resection. Mobilization of the right vygina of the colon.

698. Pancreatoduodenal resection. Mobilization of the twelve-fingered intestine according to Kocher. Dull visibility of the back wall of the intestine and the head of the small intestine is seen from the back of the intestine.

699. Pancreatoduodenal resection. Bridging the root of the breech of the transverse colon and parietal queue from the head of the bottom hole and the lower horizontal part of the twelve-fingered intestine.

700. Pancreatoduodenal resection. Maliy oil seal razs_cheniy. Bandaging and peretin a. gastroduodenalis.

1 - lig. hepatoduodenale; 2 - a. gastroduodenalis; 3 - v. portae; 4 - ventriculus; 5 - lig. gastrocolicum; 6 - caput pancreatis; 7 - duodenum; 8 - duct us choledochus.

On the flats of the collar, the shlunks are recalculated by applying zhomami і, spreading them to the sides, to expose the shyku pidshlunkovoy zalozi. Put a finger on it, insert it along the upper edge of the bottom hole, stupidly open the back surface of the bottom hole. gateway veni(Fig. 701). The zalozu on the ryvnі shiyki is recalculated between the zhomami (fig. 702). Schob uniknuti pozhkogennya vіtnoї veni pіd zalozu slіd put a grooved probe or a finger. The head is gently pulled back to the right, it is raised to the right, it is raised, it is tied and reclined, the venous vessel is pulled back, so that it can be pulled up to the back vein (Fig. 703), as well as the lower bottom-two-fingered judges. The hooked sprout in the five s-pid of the upper brijovy vessels, intertwining with the jingle (Fig. 704). Pislya tsyo vyroblyayut peretin zagalnoy zhovnoy ducts. If for the introduction of the gum, it is necessary to put on the preparation between the gum and the small intestine, then the proximal end of the posterior gut duct should be tied up with two suture ligatures and the reticulation.

701. Pancreatoduodenal resection. The slider is to the left, the cube of the twelve-fingered intestine is to the right. The appearance of the shyka is closed from the back and upper bridal veins.

702. Pancreatoduodenal resection. Peretin crawl along the grooves of the probe.

1 - lig. hepatoduodenale; 2 - v. portae; 3 - a. hepatica communis; 4 - ventriculus; 5 - corpus pancreatis; 6 - mesocolon transversum; 7 - colon transversum; 8 - caput pancreatis; 9 - duodenum.

703. Pancreatoduodenal resection. Mobilization of the rear surface of the head of the bottom hole. Ligation and overretin of the venous vessels, so that it can be inflated to the upper and upper bridal veins.

1 - lig. hepatoduodenale; 2 - v. portae; 3 - a. hepatica communis; 4 - ventriculus; 5 - v. lienalis; 6 - corpus pancreatis; 7 - v. mesenterica superior; 8 - mesocolon transversum; 9 - a. et v. pancreaticoduodenalis inferior anterior; 10 - colon transversum; 11 - caput pancreatis; 12 - duodenum.

704. Pancreatoduodenal resection. Razsіchennya zv'yazyka gachkodіbne sprodrostka.

1 - lig. hepatoduodenale; 2 - a. hepatica communis; 3 - ventriculus; 4 - v. lienalis; 5 - corpus pancreatis; 6 - v. mesenterica superior; 7 - the sound is similar to the spur; 8 - mesocolon transversum; 9 - colon transversum; 10 - a. et v. pancreaticoduodenalis inferior anterior; 11 - caput pancreatis; 12 - duodenum.

705. Pancreatoduodenal resection. Peretin of the zhavalnoy zhovnoy duct.

1 - lig. hepatoduodenale; 2 - a. hepatica propria; 3 - v. portae; 4 - a. hepatica communis; 5 - v. lienalis; 6 - v. mesenterica superior; 7 - caput pancreatis; 8 - duodenum; 9 - ductus choledochus.

For the residual mobilization of the head of the pidshlunkovoy zalozi to rewire the upper part of the twelve-fingered intestine, having tied it in front of her to her stomach (Fig. 706). The cult of cross-colonization is sewn in and peritoneized.

706. Pancreatoduodenal resection. Peretin of the lower part of the twelve-fingered intestine.

1 - lig. hepatoduodenale; 2 - v. portae; 3 - a. hepatica communis; 4 - ventriculus; 5 - v. lienalis; 6 - corpus pancreatis; 7 - v. mesenterica superior; 8 - mesocolon transversum; 9 - colon transversum; 10 - caput pancreatis; 11 - duodenum.

At once necessary visualization of the twelve-fingered intestine, the peretin of the cob portion of the small intestine should be used. Send the lower part of the twelve-fingered intestine to the upper breeches, and the small intestine to the farther vicorist for anastomoses.

The mobilized head of the slurry bed at once from the twelve-fingered intestine is seen and carried out retinal hemostasis and peritonization of the bed.

Then we proceed to the processing of the kuksi pidshlunkovoy zalozi. Most often it is necessary to apply the result of a small intestine. Such anastomosis can be carried out after the type of end-to-end or end-to-end. The first option is to stagnate more, so as the diameter of the kuksi does not depend on the appearance of the intestine.

The technique of applying anastomosis for the type of end in bik is nasty. Pass a loop of the small intestine through the opening in the bridle of the transverse colon. Cult zalozi mobilize with a stretch of 2 cm and to bring the loop of the intestine to it. Then open the bowel wall according to the transverse size of the gullet and put the first row of suture knotted sutures on the back wall of the bowel and the serous membrane of the intestine (Fig. 707).

707. Pancreatoduodenal resection. Applying anastomosis between the small intestine and the small intestine by the type of end in bic. Pidshivannya of the intestine to the back wall of the kuksi zalozi.

To another, the order of the vuzlovy seams sews the posterior edge of the kuksi into the posterior lip of the lateral opening of the intestine (Fig. 708). Writing in the same rank, or in a ringing order, impose two rows of knot seams on the front wall of the joint (Fig. 709, 710).

708. Pancreatoduodenal resection. Applying anastomosis between the small intestine and the small intestine by the type of end in bic. Pidshivannya of the rear lip and the growth of the intestine to the inner edge of the kuksi zolozi.

709. Pancreatoduodenal resection. Applying anastomosis between the small intestine and the small intestine by the type of end in bic. Pidshivannya the anterior lip and the growth of the intestine to the last edge of the kuksi zolozi.

710. Pancreatoduodenal resection. Applying anastomosis between the small intestine and the small intestine by the type of end in bic. Sewing of the anterior wall of the anastomosis on the shoulder of the high-knot gray-serous sutures.

Technique of anastomosis application between the small intestine and the small intestine by the type of end-to-end, And also the technique of sewing the duct into the small intestine after the Wyple-guided method in Fig. 711, 712.

711. Pancreatoduodenal resection. The way of imposing an anastomosis between the small intestine and the small intestine according to the end-to-end type.

712. Pancreatoduodenal resection. How to sew the slurry duct into the wall small intestine by Wyple.

Having finished the obrob of the kuksi pidshlunkovoy zalozi, start before applying it through the backbone duct, or the gummy meat and the thin intestine. Anastomosis is applied to the distal part of the mucus from the bottom.

For the introduction of zhovchі more dozіlno conduct choledochojejunostomy. There are a number of changes before the cholecystojejunostomy, as in the period of operative period it is necessary to diagnose the cholangies and sound backwards. In addition, it is not safe to cut through the kuksi zagalnoy zhivnoy duct, which is easy for cholecystojejunostomy.

The imposition of such a combination of technically awkwardly difficult with an expanded zagalny zhovchny prototype. However, as there is a grudge against sounds, then there are significant technical difficulties, in such cases it is easier to develop cholecystojejunostomy.

The technique of cholecystojejunostomy and choledochojejunostomy is shown in food.

The offensive stage of the operation is the renewal of the passage of the shlunkovo-intestinal tract. To increase the amount of grub in the gut and pancreatic ducts, the shlunk-intestinal anastomosis needs to be rostered below the overlapping anastomoses with the gut duct and the gut duct.

Shlunkovo-intestinal preparation can be applied to the chinstalk in the end or the end in the bik. For the first one, put on a dodatkova mіzhkishkovі obtained, for the other - the proximal end of the intestine is sewn tightly or sewn into the bik to insert the loops of the intestine.

In fig. 713 schematically depicts Pancreatoduodenal resection in the finished viglyad.

713. Pancreatoduodenal resection in the finished viglyad (semi-schematic).

For some people with enlargement evil new creatures on the head, just and the tail of the bottom of the slurry stick to extinguish the extirpation. Tsya operation є on the basis of the following two operations: pancreatoduodenal resection and resection of the tail and tail of the flesh-throat.

The reconstructive stage of the operation during the extirpation of the burrow should lie down when the need to impose an anastomosis between the cocks and the small intestine is found.

In a given hour, there have been described a number of different types of pancreaticoduodenal resection (PDR), as there is little evidence of one type of one. Їх vіdmіnnіst is laid down in some technical approaches, as well as in variants the form of interorgan anastomosis.

On our thought, opanuyuchi PDR technology, the surgeon is guilty of thoroughly introducing and presenting the aftermath of the skin stage of the folding operation.

As a matter of fact, the operation of the PDR is to blame for adequate surgical access. Naybіlsh zruchnym slіd vvazhati transverse, as well as the type "Mercedes". In іnshih vypadki there may be a wide middle laparotomy.

The most promising for the result of all surgical involvement of the revision. As soon as she sang, she became very bright, like a walk before the operation. Chi bude won radically or end up with one of the options for paliative supplementation.

The revision is guilty of including the offensive last days:

1. Retinal palpation of both parts of the stove. Pidopulations of universities are supervised on the basis of the term histological dosage. When an evil growth is confirmed, a radical operation is uncomfortable.

2. Palpation of the head of the bottom hole (in front of and from the side of the small curvature of the shutter).

3. Raztyaguvannya mesocolon at the transverse rim intestine. Palpation of the lower edge of the bottom of the mesocolon root. It is necessary to respect the camp of the mesenteric vessels and the recumbent outgrowth of them on the right, the hook-shaped outgrowth of the submarine furrow. "Cancer bunch" in a whole lot of messages about inoperable.

4. Palpation of the pelvic emptying and small pelvis.

5. Mobilization from the back of the 12-palate intestine and the head of the pidshlunkovaya zalozi according to Kocher up to the aorta. For the whole mobilization of the right tovstokishkovy vigin and introduced into the caudal right. Mobilization of the 2nd and 3rd sections of the 12-palate intestine is carried out bluntly with a finger, partly sending the rosette of the avascularized ligaments between the 12-palate intestine and the anterior wall of the lower empty vein.

6. The palpation of the pechin-two-twelve-fingered ring allows you to clarify - what is the reach of the pudding of the upper border of the head of the pied-slinky zone, or, according to the sound of pudding, it expands up the hill to the gates of the stove. All adolescents of lymph nodes are sent for a term histological reading.

7. Roztin electronic bags for revision of shyki til and tail of the slurry. Access to the omentum of the great omentum to the middle of the transverse rim intestine. Through the access, the station of the mesenteric vessels is residually controlled.

Upon completion of the stage of the revision and the residual decision, the possibility of performing a radical operation can proceed to the stage of resection. Remaining includes the onset of action.

1. Cholecystectomy and peretin of the pechin duct.

For cholecystectomy, there is a great deal of radicality involved, as well as prevention of the establishment of gum stones in order to adapt the mechanism of regulation of the vater pump with a visible 12-palate intestine. The last day is guilty of the offensive. Zhovchny mіkhur viluschіsіvsі from its bed subserously.

Let the mikhur arteries hang only on the mikhur ducts. Tupa and gostra preparation of the female nobles to open the vein behind them. Only now you can see zhovchny mikhur and before the lymph paths, which should lie lateral to the gateway and the cheeky paths. On the whole stage, limfodissection is carried out, which is drawn to the gate of the stove. Here, there is a permanent memory about the possibility of the appearance of an additional right-wing pechinkovo ​​artery, as, as a rule, it is customary to pass through the right way.

Without a middle proximal girdle, the ducts can see the backbone protrusion, which overshadows, fixing the proximal tip on a soft lug, and the distal tightly bandage.

2. Preparation in the area of ​​pechinkovo-twelve-fingered connection.

The neck of the sound is notched closer to the furnace. Some palpation identifies, and then we dull and walk the path to see the pechinka artery, which passes, as a rule, medial to the common bile duct. The rights and the left of the pechinkovy arteries are subsequently identified. It’s a bit lymph fabric, so it’s lying between the gates of the stove and the greenhouse. At the scene of a strong viginus of the zalous pechinkovo ​​artery and stove, there is a representation of a short and strong slunk-two-fingered artery, as in a whole mix it is tied and rewound. Residual skeletalization of the extracellular artery in the medial direction of the completion of the stage of the operation.

3. Dissection of both the gateway vein and the wider vein.

It is one of the folding and technically delicate stages of the operation. Winning a lot of freedom venous bleeding As a result of the development of venous hocks, it flows into the portal system. The stench is found strictly medially (coronary vein of the shlunk, splenic vein, inferior Brijov's vein) or laterally (small veins of the head of the intestinal tract and 12-gut). The preparation in the area of ​​the posterior surface of the lining of the lining is responsible for the observational pressure of the offensive rule. When collapsing up the hill, it is necessary to strictly trim the front surface to the upper breech, and then to the gate. As a rule, there is no time to go through here. The preparation is more beautiful with a good finger. If you are bleeding, unimpressed on all the zapobizhni, come in, winiklo, then zupinka yogo next go with a tamponade with gauze. Trying straight zupinka bleeding behind the help of the suture or ligature є procedure, in the whole "tunnel", is practically hopeless and not safe.

Next more times, the prompts of the stage of operation are key, so the surgeons look at this part of the diagnostic stage in terms of the operability of the puffin. It’s possible to wait for a third time, if there is evidence of a hepatoduodenal ulcer before manipulation. There is a local sprouting of chubby in the Great Judgment, when there is evidence of evidence in the court surgery, not at the time of the announcement and recognition of radical involvement.

4. Resection of the shlunk.

Make sure to have a resection at least half of the distal end of the shlunk. The line of resection should be passed obliquely up to the level of the "goose paw". The peretin of the shlunka is dependent on being able to work for the help of the shlunks. Ostannіmi can be equipment of the UO type or UZh-100. At the end of the stage, behind the slag, there are only pidshlunkov zaloz with the already mobileized shlunk.

5. Resection of pidshlunkovoy zalozi.

Pidshlunkovy zloza distal zone and urazhennya to rewind with an extra laser scalpel. It remains more beautiful through the possibility of a greater amount of blood and enzyme production. Vinnik of bleeding from more great Sudins is easy to fix to the stitches.

Victory of a mechanical suture, as well as soft-elastic cuffs, should not be justified through injury to the development of traumatic pancreatitis.

In case of cancer of the head of the pancreatic cavity, put the dilyanka with the resection and the line of the histological diagnosis due to the appearance of the infiltrating growth of the puffin.

6. Ligation of retropancreatic vessels.

At the whole stage in the hands of the surgeon, in one block there is a gum michur, common bile duct, the distal part of the shlunk, the right half of the omentum, 12-palate intestine, and a part of the fodder is seen. The entire preparation is fixed only in the distal part of the 12-palate intestine, on the cob-like small and retro-pancreatic space, so that it falls into the vortnu and upper bank vein. For the completion of this stage of the operation, residual mobilization of the 12 palate intestine is carried out. At the same time, the non-jarring adhesions between the third part of the 12-palate intestine and the cob of the mesocolon go up to the coracoid protuberance. Then, pull the drug to the right, reliably bandage and recoup the numerical retropancreatic veins.

7. Peretin of the small intestine.

For ligation of retro-pancreatic veins and mobilization of the hook-shaped appendix, it is unnecessary to ligate short upper jejunal vessels, as the preparation is continued. At this point, I mark the link of the Trinity. There is a line of transfer of the small intestine. Stay zdіysnyuєtsya for additional repair equipment. The proximal stump of the small intestine to upper part black wastes. The skinny judges are tightened, as they can reduce the mobilization of the organ block without any folding, tied up and overturned. With increasing mobilization, the drug is seen from the black empty. It can be seen that the given technique allows not only to carry out lymphodesection, but to correct the drug in the block, which will increase the information given to the current oncology specialists. We have promoted the method of operation, which will give the docentral preparation about the chubby, which in the process of the operation is practically not stuck.

If the process of visualization of the pancreatoduodenal complex is passed to not less folding and general stage - reconstructive stage of pancreatoduodenal resection.

It seems that, for the first time, the idea of ​​the PDR proponated A. Codivilla in 1898, and the residual operation was approved by A. Whipple (1935), who, after all, systematically viconuvati in classical practice. In a given hour, there are more than hundreds of options in the current stage, but one of the same methods is used to process the mucky pits, the internal drainage of the gutters, the renewal of the drainage

I will look around at the vyschevikladena, we are using the methods of the reconstructive stage, like having proponed C. Child (1944r.). The scheme is very simple for the Vicon. Vona includes the offsets in the overlaid anastomoses. The first to impose a pancreatojejunal anastomosis, the onset - biliodigestive and nareshty, gastro-jejunoanastomosis. Such a procedure is not safe for the throwing of a zhovchі and shlunk into the zone of pancreatojejunostomy and the ducts of the dysfunctional cavity, which, in the endocytic bag, before the diagnosis of pancreatic dermatitis, decreased

The technique of pancreatojejunostomy includes a chain of stages. The first is the introduction of the loops of the small intestine to the anastomosed organs. You can be seen as behind the brijov's ships, so it is in front of them. With a swollen infiltration of the hook-shaped appendage and more with infiltration of the upper bridle vein, i.e., if a local relapse is possible at the root of the breech, a thin intestine needs to be conducted not in the middle. Pancreatojejunal anastomosis can be formed at the telescopic end-to-end or 2-row end-to-end anastomosis. Yak butt is suggestive of a description of the technique of the first variant of anastomosis. A collection of the back wall of the small intestine is sewn up with suture threads, extending from the edges by 2-2.5 cm. The mucus of the intestine is guilty of the vision for a short time, but it did not kick in front of the Wirsung duct. Then another internal row of sutures can be applied to the posterior lip of the anastomosis. At zvorotn_y post-mortem, the front lip is formed by anastomosis. As a result, a telescopic effect is achieved, which will prevent the temple from having an anastomosis.

Indicated before pancreatoduodenal resection:

• Malicious new solution of the head of the papillary gland and the great nipple of the twelve-fingered intestine
• Cancer of the slurry
• periampular cancer
• Abscess of the head

Analyzes before pancreatoduodenal resection:

• Out-of-the-box analysis of blood and blood
• Analysis for chubby markers CA 19 9 and CEA
• endoscopic ultrasound
• CT scan of a worm

Technique of carrying out pancreatoduodenal resection:

Tse duzhe seriozna operation, as it is carried out on gallant anesthesia... Hirurg to rob the lateral rozrіz in the black emptying. In the course of the operation, one can see a part of the slurry, a part of the slurry, a gummy mikhur and two gut bowels. Regional lymph nodes are excised. Pislya resection of ciches of organs in surgery with a single shunt with a thin intestine - a sash gastroeteroanastomosis. All fabrics are listed on the histological basis, as long as possible.

The triviality of the operation:

From 5 to 7 years

Reabilitation period:

After the end of the operation, the patient will be transferred to the intensive therapy ward, and after the stabilization I will be transferred to the surgery. Patient perebuvaє pіd tsіlodoobovim visual to the medical staff of the SPCH. It is meant to be insensitive internally. A dribble will reestablish, through the yaku, food and ridina will enter the organism, if the patient is not able to independently eat and drink. Then you will be able to find a choice of food and drink. The medical staff of the Scientific-Practical Center of Surgery will provide the patient with a whole complex of rehabilitation procedures, which are focused on the renewal of functions and yaknayshvid more turning to a welcoming way of life. At 7-10, add the patient to vipisuyut.

Hirurgiya is one of the main methods of treatment of this affliction... The type of operation starts on the basis of the size and size of the pudding, the presence of secondary powers in the body, the potential for the general vision of malignant affirmation.

Until the end of the day, you can show me how to get rid of cancer in the middle of my life more successfully and not less than the men of women, how to pass at the great cancer center and visit the health care center, as a great youth.

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The operative methods for the treatment of oncology in the flesh are even more foldable. Hirurg is guilty of mother visokiy rіven maisternosti і great dosvіd, so that we want a better result. Izrailski clientele can propose the services of the most qualified and prestigious fahivts. Finding a chance for the success of the meal will give you 100% visibility of the chubby. The price of this is also the manifestation of everyday medical possession - the stagnation of strained microscopes.

The operation for cancer of the lumpy root is transferred in the main door - a view of the malignant decision in the general public or a decrease most of the views and those of the first manifestations of ailments.

Only in about 10% of cases of malignancy, the poohlin is localized in the boundaries of the slurry zone, if cancer is diagnosed.

To navigate the growth of mobility, because you cannot expect to exactly rise to the stage of becoming ill, not being involved in surgery. On the basis of the visualization of the tests, the bugs, so that they come to the notice about the operability of the chubby. However, the hour of the operation will begin to fail, so that the inoperable is not maliciously approved, but it’s second in the name.

As well as the results of diagnostics of cancer of the papillary cavity show that the puffin cannot be resected, it may be possible to perform a clinical operation. The stench is straightforward to relieve pain, the change is a sign of illness.

In the Israeli clinics, onset and visual operations are carried out in case of cancer of the pancreatic cavity. It is also possible to get stuck in other methods of therapy before any surgical engagement.

Whipple's operation (pancreatoduodenal resection) in Izrailia

Whipple's operation is most often performed in case of a disease. Vona vikorystovuєtsya for a vividly evil statement in the head of the pidshlunkovaya zalozi or in the opening of the pancreatic duct. In the process of surgical engagement, resection is carried out:

• the head of the small intestine with an ear of the small intestine (twelve-fingered intestine);
• zhovchny mіkhura;
• segment of the posterior zhovnoy duct;
• shutter collar (pylorus);
• lymph nodes close to the head of the slurry zone.

In a number of cases, a modified Whipple operation can be carried out, it does not flow into the normal function of the shlunk.

Shown before pancreatoduodenal resection

A whole type of operation is used to detect cancer, as if in the presence of a child organisms - podshlunkovy zalozu, gut ducts, gum mikhur, small intestine.

How is pancreatoduodenal resection performed?

Tse duzhe seryozna operation, as it is carried out with anesthesia. Vona triva from six to twelve years. Hirurg to rob the rozriz in the black empty, look around the organ, see the chubby, without making life important structures. Because it is a possibility, the lycar is resected in a bad way with a part of healthy tissue (so called surgical edge). Forces of tissue are sent to the laboratory, de ive pathologist, at the beginning of the stage of ailment, the appearance cancer cells in the surgical land. Primed on the results of the pathologist's medical examinations, the treatment is necessary, as long as it is necessary.

During the first hour of the Whipple surgery, the surgeon saw the head of the mucous membrane, the gum michur, the ear mucus of the small intestine (twelve-fingered), the pylorus, the segment of the posterior gut duct, to exude the lymph nodes. Pislya resection of cich organs in a vin from a single shunt with a thin intestine - a sash gastroeteroanastomosis. When a segment of the zhazhnyy zhazhny duct is lost, it can also be stuck in the thin intestine, so that the gut and pancreatic juices came to it. The stench will take away the neutralization of slunk acid, and reduce the risk of fluff in the whole area.

Give food to the lykary

Whipple's operation modified

On the basis of the standard pancreatoduodenal resection in the process of modified, the gate of the slunk is taken into account - the pilorus. This kind of surgery is not poured into the slunker, it is normally used. The writing of the modification of the operation does not lead to problems with the hankering, as in the case of the standard surgery.

Recommended for modified pancreatoduodenal resection:

• It’s just as bad as it’s not great and bulky.
• If the fluff has not grown into the cob portion of the small intestine.
• No cancer cells in lymph nodes near the gate.

Pislya pancreatoduodenal resection

Pisle of surgical involvement of ailments will be left in the doctor's office for seven to ten days. It is meant to be insensitive internally. Epidural anesthesia may be victorious or controlled by the patient's anesthesia. This is how a dribble will arise, through the yaku, the internal food and family will enter the body through the yak, as long as the ailments will not be in the snake of self-reliance and drinking. The catheter will be displaced for introducing the sect to the body. Through a few days the stench will be visible. The loan renewal process is close to month. It will take about three months before the herbal system robot is updated.

For a small amount of insulin to control the level of sugar in the blood. It is meant to be insulin until quietly, as long as the organ is not renewed during the operation and will not be able to synthesize insulin again. You can, know the intake of herbal enzymes, help the body to digest and develop fat and fat.

Whipple's operation is often used for catching chubby puffiness in children (adenocarcinomas, for example). Preparation can include a decrease in peace of mind, improvement of health, giving additional help to a child in the development of self-control tools and to lay down in a child's life. Likari and daddy will help you to get started, explain you what it will become.

Replace the non-braced dzvynok

distal pancreatectomy

I will give the operation to be victorious, if the evil is not approved to grow up in the til and the tail of the hole. In the process of promptly engaging the surgeons, they saw the tail or the tail, the segment of the body and the closest lymph nodes. yaksho pathological process having struck a spleen or a blood-bearing judgment, you will get sick with blood, you will see a spleen. The head of the small intestine should be pressed down to the cob part of the small intestine.

total pancreatectomy

Total pancreatectomy vikonutsya ridko. People look for a wide variety of surgery, if the cancer has expanded throughout the entire zone, since it is not possible to infinitely go to the small intestine. In the process of total pancreatectomy, the surgeons saw an increase in the small intestine, the cob portion of the small intestine, the pylorus, the segment of the posterior zharynka duct, the gum microscope, one of the selenium and erratic growth. Pislya tsyogo lykar z'єdnu shlunka from the thin intestine, flashing gastroenteroanastomosis. The overlapped segment of the zhazhny duct is also under the empty intestine.

Oscillations of the pidshlunkov zalosa grow out, children develop diabetes, they need to get insulin. Diabetes is often important to control.

It is also the ferment of the ferment that can help to over-graze the ferment. Pislya її resection wines the need for fermenting all life.

paliative surgery

Until you are vdajutsya, you will get rid of the symptoms in case of muscular-widened, or recurrent cancer of the adrenal gland. Novelties in the head area often block the gallbladder protrusion of the small intestine. I will pay off the operation, clean up the blockage.

stent placement

Breaking a stent is a way, until most often, you can go in, put it in a block, wickle with a chubby. A stent is a thin, empty tube, as a rule, ready for metal. Yogo razmіschuyut in a gum prototy, tighten the duct open, fix the grip on the walls from the inner side. Pislya tsyogo zhovch sticks into the small intestine.

The stent is installed to start up for an hour endoscopic retrograde cholangiopancreatography (ERCP). In some cases, they use the so-called percutaneous method, if they see the growth through the screen, then the stent will expand into the gum hole. When you put such a procedure into a bag, you will get a pose with a smile.

The stent should be removed from the skin 3-4 months or more often. Newly see stents in a wider area, you may have great powers at your place. Slow down, try to save the duct open.

surgical shuntuvannya

The installation of an endoscopic stent can be replaced by a shunt procedure, which changes the blockage, or a viclikan to new patients in a row of vipads. It is always a matter of clogging up the development of shunt surgery.

1. Choledochojejunostomy transferring the zagalny zhazhnoy duct to the empty intestine. The shunt procedure can be performed laparoscopically.
2. Hepaticojunostomy is an operation, in the course of which it is necessary to unite the pechinka duct until the empty intestine.

Shuntuvannya shlunnya or gastroenteroanastomosis - a type of shuntuvannya, if the shuntuvannya without a priori z'єdnuyu with the thin intestine. One day the operation will be stagnant, if you will find another surgical intervention, like a risik, if the intestine will be blocked twice, if the ailment progresses.

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Possible side effects of pancreatoduodenal resection

Whipple's operation is carrying a high rhizik slower. Approximately 30-50% of people who have suffered qiu surgical involvement, Not expected inheritance. It is important to look at the people who are looking for any future side effects.

1. B_l is often the result of surgery through tissue injury. For її control of vikoristovuyut analgesics by stretching out decilkoh days. You need the first hour of the first, lower than the last, to lie down during the process of getting tired and equal to the threshold of pain.
2. Rizik of infection. In the wound, you can get rid of drainage, so you can clean it up and speed up the process of firing. Likari priznachayut antibiotics, schob zapobіgti or lіkuvati іnfektsіyu. There is a time-consuming neglect of the effect that one can appear after some kind of surgical engagement.
3. Bleeding can be a legacy of problems from the throat of blood, for example, a lot of blood-bearing judgment that was not isolated in the course of the operation. Small quantity The blood can be seen in the drainage system, so that it can be looked at in the quality of the norms.
4. Vitik anastamosis. In some cases, the vitality of zhovchi, slunk acid and pancreatic juices from the known organs of the same tissue is produced. Likar can indicate okreotid (sandostatin), which can reduce the number of pancreatic juices, which can help prevent a faster process of starting anastomosis.
5. Covering the vyporozhnennya shlunka is a camp, when you put it into the shlunk more, lower it. It may occur if a partial parallel to the organ is caused as a result of a nerve reduction before the hour of the operation. Covering the vyporozhnennya shlunnaya can viklicati nudotu, blues. After 4-12 symptoms, the symptom will pass. Maybe it’s stuck through a tube to secure the necessary food. Most often, a Danish symptom is detected when a modified Whipple operation is used, but not a standard one.
6. Dumping syndrome is a group of symptoms that develop, if it quickly moves from the dump into the small intestine. Likewise, there can be no wicks to the quick wipes of the slunk. Most often, it is necessary to support the writing of the standard Whipple operation, the writing of surgery on the gate and twelve-fingered intestines... Signs of dumping syndrome include fever, cramps, abdominal pain, and diarrhea. Likars in the Israeli clientele will propose to the patient the methods of managing these mill - changes in the rationalization, or any operation.
7. Problems with eating can be attributed to pancreaticoduodenal resection, if there is a lack of herbal enzymes in the flesh, juices or juices. Tse to bring to a rotten appetite, lowering the fat intake (organism does not take away enough fatty vitamins- A, D, E and K), diarrhea, abdominal swelling and dislocation of the slunk. Likars in Izrail will be a consultant, how to save the operation healthier eating... Possibly, for patients, it is necessary to take herbal enzymes. There will also be recommendations for more private priyom, implantation of low-fat products, signs of anti-boredom, vitamins additives. As soon as there are serious problems, it is possible to find out for the help of the probe, and on the organism having removed the abundance of old-fashioned speeches.