Method for capsular pancreatic decompression

FIELD: medicine, surgery.

SUBSTANCE: one should perform incisions of parietal peritoneum by leaving 2 cm against inferior and superior edges of patient's pancreas being of 1.5 cm length to apply them in checkered order for the purpose to prevent vascular lesion.

EFFECT: higher efficiency of decompression.

1 ex

 

The invention relates to medicine, namely to surgery.

Due to the wide spread diseases of the pancreas and a high frequency of complications problem decompression of the pancreatic capsule in modern pancreatology remains topical and requires surgeons intensive searches for her permission. In particular, such pathologies such as acute pancreatitis, pancreatic necrosis, trauma of the pancreas require the surgeon to reduce the pressure of the pancreatic parenchyma on her capsule dissection of the adjacent parietal peritoneum.

The prototype of the method of decompression of the capsule of the pancreas is the operation of abdominal pancreas" by the method Wageslave. From traditional (verhnesadovogo) cut produce autopsy stuffing bags, then upon completion of the audit of the pancreas in parallel, randomly away from the lower and upper edges of the body and tail of the pancreas, regardless of the location and extent of the pathological process, arbitrary length and depth of cut parietal peritoneum. After that, for the purposes of distinguishing photoexcitation process under the pancreas fail the free end of the flap of the great seal and coat them with the iron. The operation completed adequate drainage stuffing bags and C the peritoneal space (Savel'ev V.S., Buyanov V.M., Ognev J.V. Acute pancreatitis. - M.: Medicine, 1983. S).

However, the above method has several disadvantages:

- how traumatic because of arbitrary length and depth of the incisions;

- mobilization of the pancreas is more trauma, also injured a flap of omentum, contributing to the emergence of omentitis;

longitudinal incisions are produced without taking into account the anatomy of the peripancreatic space;

- cuts contribute a massive message of the abdominal cavity and retroperitoneal space, which is undesirable when purulent-destructive processes in the pancreas.

The authors suggest that their method of decompression of the capsule of the pancreas. The operation phase of the audit of the pancreas produce traditionally, as described above in the prototype. Next, after the inspection and the establishment of localization of the pathological process in the projection from its local or total distribution produce sections of parietal peritoneum is reached 2 cm from the bottom and top edges of the pancreas with a length of 1.5 cm, staggered. If necessary, the incision can be from 1 to 3 rows, which increases the degree of stretching of the pancreatic capsule and peripancreatic space. The operation completed adequate dreni what Finance stuffing bags and abdominal cavity.

The offered method of decompression of the capsule of the pancreas has the following advantages:

1. Decompression of the pancreatic capsule is carried out locally with minimal trauma;

2. Staggered cuts ensure the prevention of the spread of purulent-destructive process in the gland by increasing the amount of its parenchyma due to the maximum stretching not only the capsule of the pancreas, but also the adjacent parietal peritoneum;

3. The proposed cuts allow to increase the cross-sectional area, and therefore, the area of the ascend, the Deco;

4. These incisions minimally reported abdominal cavity and retroperitoneal space;

5. May reduce the number of incisions at the local pathological processes in the pancreas;

6. Reducing the time of surgery due to the fact that you do not need to shroud the pancreas, a large gland and therefore no unnecessary trauma;

7. The application of the proposed method the ascend, the Deco contributes to the prevention of purulent-destructive processes in the pancreas, and therefore, reducing the length of patient stay in hospital.

The authors of the above described method was operated 17 people.

Clinical case: a case history No. 621. The patient Quiet the worlds SR, 19 delivered to the Department of surgery later, 1 hour after a car accident with a diagnosis of blunt abdominal trauma. Soon was operated. Intraoperative: after revision of the pancreas in the body on its bottom surface detected an incomplete rupture, Virunga duct is not damaged. Some distance of 2 cm from the bottom and top edges of the body of the gland, made 5 cuts on each side, with a length of 1.5 cm each, staggered in 3 rows. The gap summed tubular drainage. The surgical wound was sutured in layers. On the 9th postoperative day outflow pathological discharges drainage was not observed drains removed. The postoperative period is smooth. The patient on the 16th day in a satisfactory condition and was discharged home.

On the basis of clinical practice, the average length of stay of patients in hospital, operated on offer authors the way below, and make up 42.7 days.

The decompression method of the capsule of the pancreas, including the opening of the stuffing bags, revision and dissection of the parietal peritoneum longitudinal sections, wherein the sections of the parietal peritoneum produces some distance of 2 cm from the bottom and top edges of the pancreas with a length of 1.5 cm and have them in a checkerboard pattern.



 

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