quarta-feira, 31 de outubro de 2007

JEJUNOSTOMIA 31/10/2007

JEJUNOSTOMIA 31/10/2007

Conceito

Cirurgia que consiste na colocação de uma sonda comunicando a luz jejunal ao meio externo com o objetivo de alimentar o paciente por essa via.

Técnica Operatória

No Pré operatório pedi-se:
Hemograma Completo;
Coagulograma;
Uréia; Creatinina; Sódio e Potássio.
Iniciamos o procedimento após raquianestesia e devida paramentação e montagem da mesa de instrumentação.
A anti-sepsia é feita com povidine degermante e povidine tintura A incisão de acesso a cavidade abdominal é acima da cicatriz umbilical na linha mediana cerca de 8 cm. Após a abertura de todos os planos, identifica-se e expõe-se a alça jejunal, situada aproximadamente 20 cm do ângulo Treitz(duodeno-jejuno).Com isso selecionamos o ponto de fixação da sonda no jejuno (á 20 cm do ângulo citado).
Aplicam-se então dois pontos de reparo na alça jejunal e uma sutura em bolsa(utilizamos seda 0 ou 2.0)
Posteriormente uma pequena incisão o suficiente para passar a sonda(nº 12) é feita no centro da bolsa. Introduz cerca de 20 cm da sonda multiperfurada, no sentido do peristaltismo. Após o fechamento da sutura em bolsa é aplicado pontos em 4 e/ou L para melhor fixação.
Antes disso é realizada a interiorização da sonda através de uma incisão utilizando o Bisturí cerca de 4 cm da cicatriz umbilical no quadrante superior e esquerdo do abdome e com a pinça hemostática sinalizando o local.
Realizam-se 2 pontos com seda, fixando a seromuscular do jejuno junto ao peritônio parietal, evitando a angulação ou torção do intestino.
A sonda é fixada à pele com ponto 4 e/ou L.
Realiza-se então o fechamento dos planos do abdômen com Prolene 0 para fechamento da aponeurose e Naylon 3.0 pontos em Donati para síntese da pele. E finalmente o éter e curativo.
Lembrando que a jejunostomia pode ser feita com a finalidade de descompressão biliopancreático-duodenal, a sonda é introduzida no sentido cranial (antiperistáltico), com progressão suficiente para alcançar a região desejada, sendo as outras etapas da técnica semelhantes às descritas anteriormente.
Como complicação mais freqüente do procedimento a diarréia é a mais relatada.

145 comentários:

Anônimo disse...

Bem interessante a cirurgia, porem uma boa tricotomia prévia seria bem vinda.

Augusto Almeida disse...

Atualmente questiona-se a necessidade de uma tricotomia. Estudos de revisão sistemáticos não mostram benefícios da tricotomia prévia. Em alguns casos aumenta inclusive o risco de contamincação e infecções.

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Qual o risco de vida de um paciente com paralisia cerebral fazer a jejunostomia?

Sâmila Sales

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