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Ваші дії? - Хірургія - Форум лікарів
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Ваші дії?

Darmidon
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З нами з: 19 березня 2015, 19:29
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Ваші дії?

Повідомлення#1 » 23 жовтня 2019, 20:34

Хвора, 83роки, ампутаційні кукси на рівні стегна, непрохідність 7 діб, калова рвота.
Непрохідність поперекового відділу товстої кишки внаслідок пухлини з проростанням в пілоричний відділ шлунку та головку підшлункової залози, нориця між товстою кишкою та шлунком.
Об'єм операції?
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Полиграф Полиграфыч
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Re: Ваші дії?

Повідомлення#2 » 24 жовтня 2019, 01:04

Если целостность свища не нарушена, то - ИТА дистальнее места прорастания в желудок + интраоперационная декомпрессия проусимальных отделов кишечника. Преимущества - устраняет ОКН; предотвращает поступление химуса в зону норицi. Цекостома, как самый легкий вариант, полное освобождение правых отделов толстой кишки не обеспечит

Darmidon
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Re: Ваші дії?

Повідомлення#3 » 24 жовтня 2019, 06:50

ІТА повністю припинить пасаж в праву половину? Не думаю, перистальтика тонкої кишки активніша за товсту, піде повз анастомоз в праву половину.

Полиграф Полиграфыч
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Re: Ваші дії?

Повідомлення#4 » 24 жовтня 2019, 07:29


Darmidon
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Re: Ваші дії?

Повідомлення#5 » 24 жовтня 2019, 08:06

пухлина попереково-ободової кишки, печінковий відділ, але ж там нориця зі шлунком, кал все одно буде йти в праву половину до пухлини і дренуватися в шлунок.

Полиграф Полиграфыч
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Re: Ваші дії?

Повідомлення#6 » 24 жовтня 2019, 08:56


Darmidon
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Re: Ваші дії?

Повідомлення#7 » 24 жовтня 2019, 12:42

Нориця є -100%, пальцем визначається з кратером. Чому така впевненість,що ІТА буде затримувати пасаж хімусу. Але позиція ваша зрозуміла, опцій небагато.

Полиграф Полиграфыч
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Re: Ваші дії?

Повідомлення#8 » 24 жовтня 2019, 13:44


Darmidon
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З нами з: 19 березня 2015, 19:29
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Re: Ваші дії?

Повідомлення#9 » 25 жовтня 2019, 07:49

А як же потрапляння їжі через норицю з шлунку в товсту кишку?

Полиграф Полиграфыч
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Re: Ваші дії?

Повідомлення#10 » 25 жовтня 2019, 08:30


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