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        • Журнал Современная Онкология Том 25, №3
        • Пищеводно-кишечный (-желудочный) анастомоз: опыт открытой онкохирургии и современные возможности видеоэндоскопических технологий

        Пищеводно-кишечный (-желудочный) анастомоз: опыт открытой онкохирургии и современные возможности видеоэндоскопических технологий

        Неред С.Н. Пищеводно-кишечный (-желудочный) анастомоз: опыт открытой онкохирургии и современные возможности видеоэндоскопических технологий. Современная Онкология. 2023;25(3):346–356.
        DOI: 10.26442/18151434.2023.3.202299

        © ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.

        ________________________________________________

        Nered SN. Esophageal anastomosis: experience of open surgery and modern possibilities of video endoscopic technologies. A review. Journal of Modern Oncology. 2023;25(3):346–356.
        DOI: 10.26442/18151434.2023.3.202299

        Пищеводно-кишечный (-желудочный) анастомоз: опыт открытой онкохирургии и современные возможности видеоэндоскопических технологий

        Неред С.Н. Пищеводно-кишечный (-желудочный) анастомоз: опыт открытой онкохирургии и современные возможности видеоэндоскопических технологий. Современная Онкология. 2023;25(3):346–356.
        DOI: 10.26442/18151434.2023.3.202299

        © ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.

        ________________________________________________

        Nered SN. Esophageal anastomosis: experience of open surgery and modern possibilities of video endoscopic technologies. A review. Journal of Modern Oncology. 2023;25(3):346–356.
        DOI: 10.26442/18151434.2023.3.202299

        • Читать PDF
          Пищеводно-кишечный (-желудочный) анастомоз: опыт открытой онкохирургии и современные возможности видеоэндоскопических технологий

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        • Аннотация
        • Полный текст
        • Список литературы
        • Авторы
        Аннотация
        Наиболее слабым звеном лапароскопической гастрэктомии является пищеводный анастомоз, надежность которого, несмотря на большое количество предложенных методик, остается недостаточной. В статье представлены современные методики формирования интракорпорального пищевод­ного соустья, дана оценка их преимуществ и недостатков. Практически во всех методиках используется однорядный, преимущественно механический, шов. Вероятность сохранения герметичности однорядного пищеводного анастомоза в случае его заживления вторичным натяжением крайне мала. Как показал опыт открытой хирургии, размещение терминального отдела пищевода и первого ряда швов соустья в серозно-мышечном футляре, который образуется из стенки кишки или желудка при использовании методов инвагинации или окутывания, обеспечивает большую вероятность сохранения герметичности соустья при любом типе заживления. Расширение показаний к использованию этих способов в открытой хирургии и разработка методики интракорпорального пищеводного анастомоза с укрытием первого ряда швов стенкой анастомозируемого органа представляются перспективным направлением, которое сможет существенно снизить частоту несостоятельности швов анастомоза как в открытой, так и лапароскопической хирургии. 

        Ключевые слова: пищеводный анастомоз, лапароскопическая гастрэктомия, несостоятельность швов анастомоза, заживление анастомоза

        ________________________________________________

        The weakest link in laparoscopic gastrectomy is the esophageal anastomosis, the reliability of which, despite the large number of proposed techniques, remains insufficient. The article presents modern methods of intracorporeal esophageal anastomosis, assesses their advantages and disadvantages. Almost all techniques use a single-layered, mostly mechanical, suture. The probability of maintaining the tightness of a single-layered esophageal anastomosis in case of its healing by secondary tension is extremely small. The experience of open surgery has shown that the placement of the terminal esophagus and the first layer of sutures of anastomosis in a serous-muscular sheath, which is formed from the wall of the intestine or stomach using invagination or wrapping methods, provides a greater likelihood of maintaining the tightness of the anastomosis in any type of healing. Expanding indications for the use of these methods in open surgery and developing a technique for intracorporeal esophageal anastomosis with covering the first layer of sutures of anastomosis with the wall of the anastomosed organ seems to be a promising direction that can significantly reduce the incidence of anastomotic leak both in open and laparoscopic surgery.

        Keywords: esophageal anastomosis, laparoscopic gastrectomy, anastomosis suture failure, anastomosis healing

        Полный текст

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        Авторы
        С.Н. Неред*

        1ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России, Москва, Россия;
        2ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
        *nered@mail.ru

        ________________________________________________

        Sergey N. Nered*

        1Blokhin National Medical Research Center of Oncology, Moscow, Russia;
        2Russian Medical Academy of Continuous Professional Education, Moscow, Russia
        *nered@mail.ru


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