METHOD OF SMALL INTESTINE RESECTION IN LOCALLY ADVANCED NEUROENDOCRINE TUMOURS WITH UPPER MESENTERIC WALL INVASION

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to oncology. Median laparotomy and the abdominal cavity examination are performed to assess the prevalence of the tumour process. Resectable tumour conglomerate of mesentery of small intestine does not spread to mesocolon. Using a bipolar forceps or a harmonic scalpel, the posterior leaf of the parietal peritoneum is dissected from the lower bend of the duodenum in the medial direction along the edge of its lower horizontal branch to the level of a duodenojejunal transition. Second incision is followed by dissecting the posterior parietal peritoneum from the lower bend of the duodenum in the lower lateral direction outside the defined tumour cone of mesentery within 8-10 cm. In the area of the lower bend of the duodenum, dissection of the cell wall of the mesentery of the small intestine is performed to the level of Toldt fascia; subsequent dissection of the small mesentery wall along the planned lines of dissecting the posterior leaf of the parietal peritoneum is performed in interfacial cell space of Told. Upper mesenteric vein and an upper mesenteric artery are separated separately by a dissector with blunt-ended branches at distance of 0.5-1.0 cm from the palpated upper edge of the tumour conglomerate. Vessels are taken to tourniquets. Tissue dissection is performed along anterior mesenteric surface in distal direction. Vascular tourniquets are repositioned in the distal direction at distance of 0.5-1.0 cm from the level of infestation of the upper mesenteric vessels. Vascular tourniquets are tightened on mesenteric vessels with exposure for 5 minutes and the volume of the resected segment of the small intestine is determined, and a right-sided hemicolectomy is to be performed according to the outlined areas of intestinal wall demarcation. Clamps are applied on the superior mesenteric artery and vein proximally to the vascular tourniquets, the vessels are transected with suturing and twice bandaged. Dissection of the mesentery with the tumour conglomerate is completed in accordance with the outlined areas of the bowel wall demarcation; small intestine excision is performed. Post-dissection defect of mesentery of small intestine is closed with separate interrupted sutures. Abdominal cavity is drained.EFFECT: method enables increasing the overall survival rate of the patients, improving the patients' quality of life by preventing or eliminating life threatening local complications of the tu