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Форум лікарів • Ваші дії?
Сторінка 1 з 2

Ваші дії?

Додано: 23 жовтня 2019, 20:34
Darmidon
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?

Re: Ваші дії?

Додано: 24 жовтня 2019, 01:04
Полиграф Полиграфыч
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

Re: Ваші дії?

Додано: 24 жовтня 2019, 06:50
Darmidon
ІТА повністю припинить пасаж в праву половину? Не думаю, перистальтика тонкої кишки активніша за товсту, піде повз анастомоз в праву половину.

Re: Ваші дії?

Додано: 24 жовтня 2019, 07:29
Полиграф Полиграфыч

Re: Ваші дії?

Додано: 24 жовтня 2019, 08:06
Darmidon
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.

Re: Ваші дії?

Додано: 24 жовтня 2019, 08:56
Полиграф Полиграфыч

Re: Ваші дії?

Додано: 24 жовтня 2019, 12:42
Darmidon
Нориця є -100%, пальцем визначається з кратером. Чому така впевненість,що ІТА буде затримувати пасаж хімусу. Але позиція ваша зрозуміла, опцій небагато.

Re: Ваші дії?

Додано: 24 жовтня 2019, 13:44
Полиграф Полиграфыч

Re: Ваші дії?

Додано: 25 жовтня 2019, 07:49
Darmidon
А як же потрапляння їжі через норицю з шлунку в товсту кишку?

Re: Ваші дії?

Додано: 25 жовтня 2019, 08:30
Полиграф Полиграфыч