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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.
DOI: 10.26442/18151434.2023.3.202299
DOI: 10.26442/18151434.2023.3.202299
© ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.
________________________________________________
DOI: 10.26442/18151434.2023.3.202299
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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
Keywords: esophageal anastomosis, laparoscopic gastrectomy, anastomosis suture failure, anastomosis healing
Ключевые слова: пищеводный анастомоз, лапароскопическая гастрэктомия, несостоятельность швов анастомоза, заживление анастомоза
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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
1Blokhin National Medical Research Center of Oncology, Moscow, Russia;
2Russian Medical Academy of Continuous Professional Education, Moscow, Russia
*nered@mail.ru
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
________________________________________________
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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