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https://dspace.uzhnu.edu.ua/jspui/handle/lib/2751| Title: | Оперативне лікування хворих із синдромом езофагеальної дисфагії |
| Other Titles: | Surgical treatment of patients with the syndrome of esophageal dysphagia |
| Authors: | Шапринський, В.О. Кривецький, В.Ф. Шапринський, Є.В. |
| Keywords: | езофагеальна дисфагія, реконструктивно-відновні операції, шлунок, товста кишка, ілеоцекальний сегмент |
| Issue Date: | 2014 |
| Publisher: | ТОВ "Спектраль" |
| Citation: | Шапринський, В. О. Оперативне лікування хворих із синдромом езофагеальної дисфагії [Текст] / В. О. Шапринський, В. Ф. Кривецький, Є. В. Шапринський // Науковий вісник Ужгородського університету : Серія: Медицина / відп. ред. В.І. Русин. – Ужгород: Спектраль, 2014. – Вип. 1(49). – С. 192–195. – Рез. англ. – Бібліогр.: с. 194 (7 назв). |
| Series/Report no.: | Медицина; |
| Abstract: | Стаття присвячена оперативному лікуванню пацієнтів із синдромом езофагеальної дисфагії. Проведено аналіз оперативного лікування 160 хворих на стенозуючі захворювання стравоходу за період з 1993 по 2013 роки. Встановлено покази до кожного конкретного способу виконання езофагопластики. Запропоно- вана інфузійна терапія з метою профілактики ішемічних розладів у трансплантаті, пластика шлунком в мо- дифікації клініки та пластика ілеоцекальним сегментом. Ключові слова: езофагеальна дисфагія, реконструктивно-відновні операції, шлунок, товста кишка, ілеоце- кальний сегмент |
| Description: | There are a lot of esophagoplasty methods in the world. But there is no single opinion as to the choice of one or the other esophagoplasty method for a certain situation. Esophagoplasty can be performed with the gastric tube, small and large intestine. That’s why the transplant choice while creating an artificial esophagus, its conduction pathway, location, types and methods of esophageal-organ anastomosis formation remain the most debatable issues. A retrospective analysis of the reconstructive and restorative operative interventions in 160 patients with stenosing esophageal diseases was conducted. There were 36 patients with postburn strictures of esophagus, 3 – with postoperative scar strictures, 5 – with strictures caused by reflux-esophagitis, 38 – with esophageal achalasia, 64 – with esophageal cancer, 3 — with esophageal leiomyoma and 11 patients with esophageal diverticulum. All the patients underwent complete clinical laboratory examination and instrumental methods of examination (ultrasound, spiral computed tomography) were applied with obligatory examination of the barium passage and determination of the esophageal obstruction degree. Before the main operation stage it was obligatory for the patients subject to esophagoplasty to undergo the proposed fluid therapy 24 hours before the operation, intraoperatively and during the postoperative period. Esophagoplasty with the large intestine was performed in 28 patients. At clinic it is preferred to perform isoperistaltic retrosternal esophagoplasty with the colon segment consisting partially of the ascending, transverse and part of the descending colon with preservation of blood supply due to the left colic artery. During the preoperative period for studying of the large intestine angioarchitecture the angiographic study was carried out (Invention Patent of Ukraine No. 103847 of 25.11.2013 "Method of preparing the colonic transplant for esophagoplasty"). At clinic antireflux anastomosis between the transplant lower end and anterior wall of stomach in the antrum is formed according to the clinic method (Invention Patent of Ukraine No. 103862 of 25.11.2013 "Method of forming antireflux cologastroanastomosis"). Postoperative complications included: esophagocolic anastomotic leak (1), partial esophagocolic anastomotic leak (2), during late postoperative period – stricture occurrence. 3 patients died. Esophagoplasty with the stomach was performed in 49 patients. We prefer transhiatal extirpation of the esophagus and plasty with the gastric tube according to Chernousov as modified by the clinic method and namely the original method of stomach transplant lengthening (Useful Model Patent of Ukraine No.85680 of 25.112013 "Method of stomach transplant lengthening"). Complications after plasty with the stomach included: partial esophagocolic anastomotic leak in 5 patients after Lewis operation and in 2 patients after plasty according to Chernousov. 1 patient died. 13 patients underwent developed esophagoplasty with the ileocecal segment and preservation of blood supply due to the iliac colonic artery and vein (Useful Model Patent of Ukraine No.78206 of 11.03.2013 "Method of esophagogastroplasty with the ileocecal segment"). This type of plasty was applied to 10 patients with cancer of the lower third of esophagus and stomach with invasion into the transverse colon and to 3 patients in case of combined burn injury of the esophagus and stomach and impossibility of using the large intestine segment due to a non-marked marginal artery. The patients subject to esophagoplasty should obligatory undergo complete and complex laboratory examination as well as instrumental examination during the preoperative period including 3-D spiral computed tomography and angiography. In our opinion, the best method of esophagoplasty with fewer postoperative complications is the plasty with the stomach according to Chornousov as modified by the clinic with formation of only one esophagogastroanastomosis out of the pleural cavity. If it is impossible to use stomach and in case of a well-marked marginal artery the isoperistaltic retrosternal colonic plasty with preservation of blood supply due to the left colic artery is indicated. The proposed method of esophagogastroplasty with the ileocecal segment is used on simultaneous injury of the esophagus and stomach, its use provides creation of an appropriate reservoir (blind gut instead of stomach), antireflux mechanism and allows to prevent occurrence of peptic ulcers and strictures of the transplant. Key words: oesophageal dysphagia, reconstructive surgery, stomach, colon, ileocecal segment |
| Type: | Text |
| Publication type: | Стаття |
| URI: | https://dspace.uzhnu.edu.ua/jspui/handle/lib/2751 |
| Appears in Collections: | Науковий вісник УжНУ Серія: Медицина. Випуск 1 (49) - 2014 |
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