Resection of a small intestine

Description:

The piece of a small intestine which is subject to a resection is removed in a wound and the surgery field is protected gauze napkins from possible pollution by intestinal contents. On the bringing and taking away ends of an intestinal tube impose intestinal presses on two from each party. Having tied up vessels, cut a mesentery between ligatures. Posyole of it between intestinal presses cut the deleted gut uchasyotok on both sides (fig. 1).

The received two gleams of the bringing and taking away otyorezk of a gut bring closer to each other side poverkhyonost in the form of "double-barreled gun" and impose an anastomosis of horses in the end. For this purpose edges of prosveyot of guts prilegayuyoshchy to each other through all layers sshiyovat continuous catgut sutures. The first seam is naklayodyvat so that it zakhvatyyovat leaves of a mesentery and myyoshechny layers of both pieces of a gut. The subsequent stezhyoka of a continuous suture zakhvayotyvat all layers of an intestinal wall. Vkola needles to provide the best prileganiye of serous covers, make from mucous (fig. 2). After full a soyedineyoniya of the ends of a gut remove presses, gauze salyofetka and tools change. Hands are washed with solution of corrosive sublimate or change gloves.

The second floor of serous and muscular knotty silk seams impose 1 cm on all okyoruzhnost of a bucketed intestinal tube. After that sew up with catgut seams an opening in a mesentery, стре­мясь not to wound vessels that is followed by a bystry obyorazovaniye of a hematoma.

Use tekhnicheyosk simpler technique of bowel resection with an anastomosis a side sideways more often. The gut from each party is cut between two strong ligatures. Stumps of a gut grease 5% with iodic tincture and immerse purse-string seams  (fig. 3). The ends of the bringing and taking away pieces of a gut put to each other  side  surfaces throughout 6 — 8-cm and sew the knotty silk seams taking a serous muscular layer. Threads, except for two extreme seams, cut off. Having receded from the put stitches on 0,7 — 1 cm, open both pieces of a gut with slits, not doyokhodyashchy to the last seams on 1 cm. Then naklayodyvat through all layers of a stenyoka a continuous catgut suture on adjacent edges of the cut guts (fig. 4). The same seam sshiyovat also the opposite edges of cuts of guts, vkayolyvy a needle from a sliyozisty cover. Over a continuous suture nakladyyovat knotty silk seams. The opening in a bryzheyyoka is sewn up with thin catgut seams.