Method for treating the cases of destructive pancreaticonecrosis aggravated with retroperitoneal space infection

FIELD: medicine.

SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.

EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.

5 cl, 1 dwg

 

The invention relates to medicine, namely to surgery, and can be used in the treatment of pancreatic necrosis.

There is a method of drainage stuffing bags with pancreatic necrosis, which drains injected into the packing bag through separate incisions of the abdominal wall in the right or left podrebarac [1, 2].

The disadvantage of this method is the use of “blind” drainage tubes inserted when the drainage in the packing bag through separate incisions on the abdomen. If this is not achieved adequate drainage of the retroperitoneal space.

There is a method of drainage of the retroperitoneal space in acute destructive pancreatitis, namely, that the drainage is carried out with both sides through the space between the fascia of Toldt colon and rectum, as well as introduce additional drains on the right and left in colourtone space delimited by the fascia of Toldt and predpechatnoy fascia [3].

The disadvantage of this method is the use of “blind” drains entered in the retroperitoneal space on both sides. This method is not flowing washing purulent foci of inflammation. The method is limited to drainage only retroperitoneal space and does not involve drainage of stuffing bags from the abdominal cavity.

The method of drainage of saposhinkoviadivaricata in acute destructive pancreatitis taken for the prototype, since there are common features with the stated method: during operation produce abdominal pancreas is drained by the retroperitoneal space, the area of perirenal tissue left or right.

The aim of the invention is to improve results, increase of efficiency of treatment of patients with pancreatic necrosis.

This goal is achieved by the fact that through the fiber space between the fascia of Toldt colon and rectum spend one or two cross-drainage tube with lateral perforations, entered through the left lobotomise incision and brought out through the right of laparo-lobotomise incision through the drainage tube continuously conduct the flow-through washing retroperitoneal space antiseptic solutions as room temperature and chilled with antiseptic solutions, and when conducting a flow of rinsing it through the drain tubes on the one hand connected system with antiseptic solutions, and on the other hand the suction and hold constant suction, through a channel in the cellular tissue space between the fascia of Toldt colon and rectum do with the use of tools of laparoscopic set under visual overview with the introduction of the gas in the retroperitoneal tissue.

The method is illustrated by the drawing, which shows the positions of others the capacity of the tubes in the retroperitoneal space: 1 - right of laparo-lobotomise section.

The method is as follows.

After laparotomy through the gastrocolic ligament reveal packing bag and found the destructive signs of pancreatic necrosis with involvement in the inflammatory process retroperitoneal space, the lower edge of the pancreas is dissected parietal peritoneum - produce abdominal pancreas and prepare the chin pancreas from the underlying tissue. Then in the right side of the abdomen with the transition to the lumbar region on the posterior axillary line makes laparo-lobotomise section 1 length of 7-10 cm below the transverse fascia. In the field of hepatic angle of the colon 2 level transition folds of peritoneum 3 make the cut fascia of Toldt 4 and fall into the space 5 between colon rectum 6 and fascia of Toldt 4. Stupid way into the space between the fascia of Toldt colon and rectum medially behind the downward Department duodenum 7 and pancreas 8 make the wound channel 9, which enter the drainage tube 10. After that, the rear-axillary line in the left lumbar region make another incision 11 length of 7-10 cm to the transverse fascia, which is then cut and get into the fiber space 5 located between the retroperitoneal fascia of Toldt 4 and descending colon rectum 12. Stupid way in medial the direction in this space make the wound channel 13 behind the pancreas 8 towards previously made channel 9 on the right side, in the retroperitoneal space are the end of the drainage tube 10, is introduced into the wound channel 9 on the right side. The drainage tube 10 output through the wound channel 13 in the left lumbar region and parallel to it spend another drainage tube 14. On through the tubes 10 and 14 every 5-7 cm do lateral perforation 15. The efficiency of the functioning of the drains checked by the introduction of a saline solution or furacin, drains fixed to the skin edges 16 of the side lobotomies cuts. In the cases of distribution of purulent process in predpechatnoy space 17 between the fascia of Toldt and predpechatnoy fascia 18 is cut through the fascia of Toldt and drain purulent numb separate drainages.

If you are involved in purulent process perinephral fiber 19 is opening and drainage of perirenal tissue through a separate lobotomizes the sections on the affected side. Additionally, drain packing bag 20 through two drainage tubes with many lateral perforations, which are carried out through the left lumbar incision 11 behind the downward Department of colon 12, packing bag 20 along the bottom edge of the pancreas 8, is brought out through the packing bag in the projection of the pancreatic head 21 into the abdominal cavity 22 and out through the right laparo-l is botanicheskii section 1. Then restore the integrity of the stuffing bags by suturing of the window in the gastrocolic ligament, drain the abdominal cavity, placing cholecystostomy and perform intubation of the small intestine nasogastrointestinal probe. After that the abdominal cavity is tightly sutured. On the second day after the operation, conduct the flow-through washing purulent foci and cellular tissue areas through drainage tube of antiseptic solutions of ordinary temperature or chilled solutions using vacuum aspiration.

The method applied in the treatment of two patients.

Example 1. Patient I., aged 40, and/b 2534, 30.08.2000 was operated on for acute destructive of pancreatic necrosis complicated by abscess retroperitoneal space. During the operation was uncovered stuffing bag and made abdominale pancreas by dissection of the visceral peritoneum at the lower edge of the pancreas, then iron bluntly separated from the rear fiber space in the direction away from the body to its tail. Rear-axillary line made by laparo-lobotomise cut to the transverse fascia length of 10 cm, then dumb by the open space between the fascia of Toldt colon and rectum on the right side. On the left side on the rear axillary line made lobotomise the cut length of 10 cm, through which falling behind the th colon opened the transverse fascia and blunt made by the channel in the cellular tissue space between the colon rectum, the pancreas and retroperitoneal fascia of Toldt. After this is carried out through the drainage tube through the packing bag and through the formed channels in the retroperitoneal space, restored the integrity of the stuffing bags by suturing of the window in the gastrocolic ligament, the deduced cholecystostomy, the jejunum entered nasogastrointestinal probe. After the operation was conducted flow-through washing purulent foci and cellular tissue areas. However, after 1.5 months after surgery for drainage in the left lumbar region appeared fecal discharge due to the formation of the fistula splenic angle of the colon at the point of Griffith. 02.11.01 during relaparotomy was imposed double-barrel transversostomas. Condition improved Discharged to outpatient treatment in a satisfactory condition and functioning transversostomas. During a follow-up examination of the patient revealed a narrowing in the region of the splenic angle of the colon with impaired patency of it on the former site of the fistula. 29.11.01 the patient made a resection of the narrowed section of the colon, liquidated transversostomas and imposed transversospinalis end-to-end. Complications after surgery was not. Discharged 11.12.01 with recovery.

Example 2. Patient B., 54 years old, and/b 401564 operated urgently 15.0.2000 for acute destructive pancreonecrosis, complicated by abscess retroperitoneal space and diffuse peritonitis. During laparotomy was abdominal pancreas, derived cholecystostomy, drained packing bag, retroperitoneal space through parallel drainage tubes with lateral perforations. The abdominal cavity is washed with antiseptic solutions and drained. After the operation was conducted intensive treatment, flow-through washing stuffing bags and retroperitoneal space. 24.02.2000 during relaparotomy eliminated adhesive intestinal obstruction, bred of cecostomy through which conducted intubation of the small intestine. Other complications were not. After remitting inflammatory phenomena drains were removed, the Patient was discharged to outpatient treatment. After 6 months, the patient is examined. 12.09.2000 of cecostomy was closed unblushing way. Discharged with recovery.

Thus, the essential advantages of the proposed method is effective in the treatment of destructive pancreatic necrosis complicated by abscess retroperitoneal space and purulent paranephritis. As a result of through drainage nekrotizirovanne pancreas surrounded efficient drainage system as the front - side stuffing bags, and back through the retroperitoneal simple is ansto. This inflammatory process in the pancreas and retroperitoneal space flows in a continuous flow-through washing with antiseptic solutions, which greatly reduces the number of complications and increases the efficiency of treatment of patients with pancreatic necrosis.

Sources of information

1. Savel'ev V.S. Guide emergency surgery of the abdominal cavity. M.: Medicine, 1986, s-369; Bruce p. g et al. A comprehensive treatment of various forms of acute pancreatitis // First Moscow international Congress of surgeons. Moscow, 1995, s-166.

2. Chernov NR. et al. To the question of improving the drainage and flow of the washing retroperitoneal space when pancreonecrosis // First Moscow international Congress of surgeons. Moscow, 1995, s-192.

3. Author's certificate. The USSR 1292741 A1, And 61 In 17/00 from 28.02.87.

1. How destructive treatment of pancreatic necrosis complicated by abscess retroperitoneal space, including abdominal pancreas, drainage of the retroperitoneal space through separate incisions on the right and left, characterized in that in the region of the hepatic angle of the colon at the level of the transition folds of the peritoneum with an incision of the fascia of Toldt, dull through the space between the fascia of Toldt colon and rectum behind the medial descending from the ate of the duodenum and the pancreas make the wound channel, which enter the drainage tube, which is output through the wound channel in the left lumbar region.

2. How destructive treatment of pancreatic necrosis complicated by abscess retroperitoneal space according to claim 1, characterized in that through the drainage tube continuously conduct the flow-through washing with antiseptic solutions.

3. How destructive treatment of pancreatic necrosis complicated by abscess retroperitoneal space according to claim 1, characterized in that, during the flow-through washing purulent foci of inflammation and cellular tissue areas using chilled antiseptic solutions.

4. How destructive treatment of pancreatic necrosis complicated by abscess retroperitoneal space according to claim 1, characterized in that, when conducting a flow of rinsing it through the drain tubes on the one hand connected system with antiseptic solutions, and on the other hand the suction and always aspirate.

5. How destructive treatment of pancreatic necrosis complicated by abscess retroperitoneal space according to claim 1, characterized in that the through channel in the cellular tissue space between the fascia of Toldt colon and rectum do with the use of tools of laparoscopic set under visual overview with the introduction of the gas in the retroperitoneal tissue.



 

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