Method for surgical management of chronic pancreatitis complicated by formation of pseudocysts of head, body and tail of pancreas
SUBSTANCE: distal pancreas resection is performed. That involves transecting a parenchyma to the right from a superior mesenteric vein. That is followed by a resection of an anterior surface of the pseudocysts of the head of pancreas. A Roux pancreatocystojejunoanastomosis with isolated enteric loop is created.
EFFECT: reduced intraoperative injuries and risk of postoperative complications, lower extent of the operation, preserved portion of the pancreatic parenchyma and physiological passage of food and bile in the gastrointestinal tract by the distal pancreas resection and created pancreatocystojejunoanastomosis with the cyst walls and the anterior surface of the head of pancreas.
The invention relates to medicine, namely to abdominal surgery, and can be used during surgery for chronic pancreatitis complicated by formation of pseudocyst head, body and tail of the pancreas.
Surgical treatment of patients with chronic pancreatitis and the presence of pseudocyst remains a difficult task that often requires extensive operations on the abdominal organs. One of the possible variants of surgical treatment of chronic pancreatitis complicated by formation of pseudocyst head, body and tail of the pancreas, is a Subtotal resection of the pancreas (S. Gourgiotis, Germanos S. and Ridolfini, M. P., Surgical management of chronic pancreatitis; 2007; 6; 121-133). Surgical treatment involves the removal of the tail, body and head of the pancreas along the lateral edge of the upper anterior pancreaticoduodenal artery and suturing the stump of the organ.
The disadvantage of this method are the complexity of the operation due to the presence of pseudocyst in the cult of the body and, consequently, a high risk of developing pancreatic fistula. This complication occurs in 10-30% of cases after resection interventions on the pancreas (č F, Jon V., Subrt Ζ. et al. Pancreatic fístula - definition, risk factors and treatment options; 2013; 92(2): 77-84; Dominguez-Comesaña V., Gonzalez-Rodriques J. F., Ulla-Rocha J. L. et al. Mobidity and mortality in pancreatic resection. 2013).
Another method of treatment of this disease, more radical, is total pancreatectomy. Manipulation involves removing the whole pancreas, distal stomach, duodenum, proximal portion of the thin, distal common bile duct and spleen (Ε John. Skandalakis, Gene L. Colborn, Thomas A. Weidman, Roger S. Foster, Jr., Andrew N. Kingsnorth, Lee J. Skandalakis, Panajiotis N. Skandalakis, Petros S. Mirilas Skandalakis' Surgical Anatomy; Ch. 21, 2004). For total pancreatectomy is characterized by high volume operations, a serious post-operative complications with the development of insulin-dependent diabetes mellitus and malabsorption due to exocrine insufficiency (S. Gourgiotis, Germanos S. and Ridolfini, M. P., Surgical management of chronic pancreatitis; 2007; 6; 121-133).
The natural effort to reduce the risk of postoperative complications and the implementation of more conservative surgery has led us to develop our own method of treatment of such patients.
The object of the invention is to improve the efficiency of surgical treatment for patients with chronic pancreatitis complicated by formation of pseudocyst head, body and tail of the pancreas, by reducing the morbidity of surgical intervention and the risk of postoperative complications.
The problem is solved by performing a distal resection of the pancreas� cancer, characterized in that the distal resection of the pancreas is carried out by crossing the parenchyma to the right of the superior mesenteric vein, and then carry out a resection of the anterior surface of pseudocyst the head of the pancreas and form pancreaticoduodenectomies with a dedicated loop of the small intestine Roux.
Distal resection of the pancreas, we performed by the standard technique of crossing the body to the right of the superior mesenteric vein. Resecure front surface of cysts in the pancreatic head. Performed instrumental revision of the main pancreatic duct. Then select a loop of the small intestine Roux, disabled Department supplied behind the colon into the stump of the pancreas. Overlay pancreaticoduodenectomies with the walls of the cysts and the anterior surface of the pancreatic head with a continuous suture.
Thus, we have developed a method of treatment of patients with chronic pancreatitis complicated by formation of pseudocyst head, body and tail of the pancreas, allows, on the one hand, to reduce the invasiveness of the surgery but compared with total pancreatectomy, on the other hand, reduces the risk of pancreatic fistula compared with Subtotal pancreatectomy.
The following examples illustrate the method of the invention.
Patient �., For 39 years.
Diagnosis primary: Primary chronic relapsing pancreatitis.
Related disease: diabetes mellitus type 2 in the stage of decompensation.
Complications primary diagnosis: Formation of pancreatic pseudocysts.
From the anamnesis: the first attack of abdominal pain noted in 2004, after errors in diet, the ambulance rushed to hospital in a residence where there was a suspected acute appendicitis. At emergency laparotomy in abdominal cavity revealed a hemorrhagic effusion in pancreas cysts; performed speaktome, the abdominal cavity. If further treatment from another medical institution cyst of the pancreas puncture drained. Since 2008 periodically worried about the pain, since August 2012, the pain was constant. 06.09.2012 was urgently operated, performed diagnostic laparoscopy (alpha amylase effusion abdominal cavity - 8200 u/ml).
Then I entered the fsbi national research centre of surgery RAMS for treatment. When examined by CT abdomen pancreas sharply thickened, markedly heterogeneous structure due to the multiple conglomerate inclusions of high density and drain avascular cysts with a diameter of 5.5 cm, associated with a pancreatic duct. Parapancreatic tissue around the head is sealed with strips�Oh accumbens effusion in hepato-duodenal area and gallbladder bed.
28.11.2012 performed distal pancreatectomy with crossing the parenchyma to the right of the superior mesenteric vein, resection of the anterior surface of cysts in the pancreatic head, pancreaticojejunostomy off on a loop of the small intestine Roux. Verkhnesadinsky laparotomy with excision of postoperative scar. At audit of whole pancreas presents photoelasticity cysts. The largest diameter of the cyst in the pancreas head about 6 cm in the Pancreas is mobilized by top and bottom edges. Made the mobilization of the gland from tail, vascular structures coagulated, stitched or bandaged. Splenic vein tied at 5 mm distal to the superior mesenteric vein. Pancreas crossed to the right of the superior mesenteric vein. Parenchyma and Virunga duct contain concretions removed. Virunga duct at the level crossing about 6 mm. Resected anterior surface pseudocyst of the pancreatic head, traced Virunga duct. Some distance of 40 cm from the ligament of Trace off loop after Roux summed up in reregistration space through the mesentery of the transverse colon and pancreaticoduodenectomies continuous suture.
The postoperative period was uneventful. Control drainage from the area of pancreaticojejunostomy UD�flax on the 3rd day. The patient was discharged in satisfactory condition on the 9th day after the operation. In blood test at discharge: ar. 3,66x10 /l; HB 119 g/l; Ht of 34.5%; a clot. 319x109/l; leukocytes 9,6x109/l, bilirubin Ls. 12.1 µmol/l; protein Ls. 62 g/l, albumin 32 g/l; glucose 8.5 mmol/l; ACT 30 U/l; ALT 50 u/L.
Pain syndrome was arrested.
Our proposed method allows to reduce the volume of operation, save the part of the parenchyma of the pancreas and the physiological passage of food and bile in the gastrointestinal tract. As a consequence, reduced during surgery, eliminating the occurrence of complications such as failure of hepatic and gastronomists, decreases the risk of endo - and exocrine insufficiency, postoperative period runs more smoothly with the early activation of patients. Furthermore, the presence of formed fibrous walls pseudocysts allowed to impose strong pancreaticoduodenectomies with minimal likelihood of insolvency.
The developed method allows us to perform an adequate extent of surgery with minimal invasiveness and low risk of complications compared to traditional methods of treatment.
A positive result allows to expect that the proposed method will find wide application in the treatment of patients with chronic �ancreatitis, complicated by the formation pseudocyst head, body and tail of the pancreas.
Method of surgical treatment of chronic pancreatitis complicated by formation of pseudocyst head, body and tail of the pancreas, comprising a distal resection of the pancreas, characterized in that the distal resection of the pancreas is carried out by crossing the parenchyma to the right of the superior mesenteric vein, and then carry out a resection of the anterior surface of pseudocyst the head of the pancreas and form pancreaticoduodenectomies with a dedicated loop of the small intestine Roux.
SUBSTANCE: invention refers to systems for applying a filling material onto a working surface and can be used for applying a multicomponent compound, such as a surgical filling material for a tissue mass. A mixture feed device comprises a Luer mandrel sub-assembly, a cannula and a nozzle atomiser sub-assembly. The Luer mandrel sub-assembly is formed to contact at least two containers and forms the first and second fluid pipes of the mandrel for facilitating the flow of the first and second components. The cannula comprises the first and second cavities carrying the fluid. Each cavity is fluid connected to one of the first or second fluid pipes of the mandrel. The nozzle atomiser sub-assembly is arranged at the end of the cannula and involves at least a part of a nozzle insert placed into a nozzle cap. The nozzle cap has an end wall with an outlet therein. The nozzle insert and nozzle cap form at least three feed channels and are configured to limit at least three fluid passages in three respective feed channels. Each of the three feed channels is fluid connected to the fluid passage.
EFFECT: more effective mixing of the components, prevented cross-contamination of the components and facilitated fluid feed.
12 cl, 25 dwg
SUBSTANCE: invention refers to traumatology and orthopaedics and is applicable for joint drainage in revision endoprosthesis replacement. A drain tube is inserted into a wound with implanting a bone cement spacer containing an antibiotic. Within the first 24-48 postoperative hours, the fluid content is actively gradually evacuated from the postoperative wound every hour for 10-15 minutes.
EFFECT: method enables increasing the antibacterial effect.
SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology, and can be used in myringoplasty, for repairing partially lost anatomic structures, such as tympanic membrane. The surgery is performed with local or general anaesthesia. A tympanic membrane defect is closed with a thinned prepared alloplant in the form of an allogeneic cartilage plate. Before implanting, the alloplant is fragmented up to 0.2-0.3 mm thick and 0.8-0.9 cm in diameter that is followed by placing the plate into a bottle with a fixing fluid. The final stage of the operation involves placing the alloplant on the edges of the tympanic membrane defect. The cartilage plate is supposed to be more by 1.0-1.5 mm in size with the plate edges to be ovelapped with the acoustic meatus skin. The acoustic meatus is packed.
EFFECT: method provides the reliable fixation of the alloplant, preventing its postoperative dislocation and retraction, audiological characteristics of the alloplant as close to the characteristics of the normal tympanic membrane as possible, the absence of implant rejection and pronounced immune response, proteolytic enzyme stability, necessary rigidity of the cartilage plate, reduced length of the intervention, the absence of a cosmetic auricle defect.
SUBSTANCE: surgical management of colon cancer is required in low colonic obstruction. A midline laparotomy and abdominal organs inspection is followed by colon mobilisation. A colonic segment with a tumour is resected. The segmented intestine is decompressed with an electric suction machine. The rectal stump is stitched with a stapling apparatus. A superposed segment of the segmented intestine is mobilised to be brought down. A tunnel is formed behind the rectal stump from the side of the anus as close as possible to the oral end of the stump. A hole is formed along the posterior wall with an electric knife and used to bring down the mobilised segmented intestine by means of a guide. The intestine is fixed to the hole borders with four stitches. The excessive intestine is brought out through the anus and fixed to the perineal skin. A dioxidine solution is administered into the abdominal cavity. The rectal stump is daily washed with antiseptic solutions until the excessive brought out intestine is dissected away on the 10-14th day.
EFFECT: method enables applying the primary stitch-free colorectal anastomosis, requires no rehabilitation stage of treating colon cancer by the natural formation of the anastomosis and prevention of its leakage; it also reduces the length of disability and improves the patient's quality of life.
1 ex, 2 dwg
SUBSTANCE: axial line of two enclosing incisions is marked by connecting the centres of outer mouths of fistula sequentially from up to down by a wavy line. That is followed by making two wavy enclosing incisions parallel with the axis: right and left at 20 mm from the axial line. The left incision starts 15 mm above the proximal outer mouth of fistula, and ends 15 mm below the distal outer mouth of fistula, whereas the right incision starts at the level of the proximal outer mouth of fistula and ends at the level of the distal outer mouth of fistula. Thereafter, RPF is excised in the radial direction. Two L-sutures relaxation incisions are made. The upper relaxation incision originates from the point at the beginning of the right enclosing incision and extended to the point at the beginning of the left enclosing incision and 20 mm further, turned at a right angle 25 mm upwards, and an upper triangular adipocutaneous flap is formed. The lower relaxation incision originates from the point at the end of the left enclosing incision and extended to the point at the end of the right enclosing incision and 20 mm further, turned at a right angle 25 mm downwards, and a lower triangular adipocutaneous flap is formed. That is followed by closing a wound defect by adipocutaneous repair by shifting the formed upper and lower triangular adipocutaneous flaps onto the wound defect and fixing them with interrupted sutures. The lower edge of the upper adipocutaneous flap is fixed to the right enclosing incision, and its upper edge - to the left enclosing incision. The lower edge of the lower adipocutaneous flap is fixed to the left enclosing incision, and its upper edge - to the right enclosing incision; thereafter, the wavy s are closed.
EFFECT: more effective surgical management of recurrent pilonidal fistulas, reduced number of complications and recurrences and improved aesthetic effect of the operation.
SUBSTANCE: own finger artery, dorsal vein and own finger nerve of the fifth finger are cut and bandaged. A common finger artery of the transplant is sutured with own finger artery of the third finger stump. The dorsal vein of the transplant is sutured with the dorsal vein of the stump. Own finger nerve of the transplant is sutured with own finger nerve of the stump.
EFFECT: method improves results of treatment due to the correspondence of dimensions of the transplanted finger vessels to the dimensions of the vessels of the recipient area.
SUBSTANCE: tumour is removed by a laryngectomy within the boundaries of health tissue together with an underlying part of a thyroid cartilage. The upper and lower parts of the thyroid cartilage not involved into the tumour process are presented on the involved side in the form of horizontal plates 6.0-8.0 mm wide. A skin flap is cut out on the neck 0.4 cm more than the width of the created larynx defect, while its length is supposed to be equal to the one of the defect. The skin flap is thrown over the preserved fragments of the thyroid cartilage. That provides restoring the removed part of the larynx. The flap is anchored with single sutures to the intact mucosa of the preserved parts of the larynx along the perimeter of the defect. A lumen of the newly formed larynx is packed. A laryngostoma and a tracheostoma is formed. A tracheostomic tube No. 5-6 is inserted into the tracheostoma. A dressing is applied.
EFFECT: method provides performing the functionally conservative surgery, preserving the natural respiratory and vocal functions, reducing postoperative inflammatory complications, preventing a laryngeal lumen stenosis and rehabilitating its functions, reducing a rate of intraoperative injuries and a length of staying in hospital, improving the patient's quality of life, making it possible to start a radiation therapy by preserving the intact upper and lower parts of the thyroid cartilage and repairing a laryngeal side wall with the thrown-over skin flap cut out on the neck.
4 dwg, 1 ex
SUBSTANCE: oesophagus is separated. Oesophageal wall injuries are detected. A through drain tube with perforations is delivered through the defects in the oesophageal walls. One through drain tube is delivered through two oesophageal defects simultaneously. The drain tube holes are placed in the oesophageal lumen. The oesophageal defects are closed up to the drain tube. The tube is delivered through pedicle grafts pre-excised of proper tissues. The above grafts are used to fasten suture lines on the oesophagus. The drain tube - through counter apertures.
EFFECT: method for transoesophageal through drainage reduces the length of treatment by adequate sanitation of a mediastinal septum and oesophageal defect and conditions for their independent healing.
SUBSTANCE: kidney is approached. It is mobilised. An involved segment of the kidney is dissected away by means of laser light. When dissecting the involved segment away, the vascular blood flow of the renal pedicle is preserved. The involved segment is dissected away by focused continuous laser light at wave length 970 nm. The light power for excising a renal capsule makes 25-35 Wt. The light power for excising a renal cortex makes 40-45 Wt. The light power for excising a renal cortex makes 55-60 Wt. The surgical area is drained. The incisional wound is closed.
EFFECT: method enables avoiding the intraoperative renal parenchyma ischemia, provides minimum injuries of the renal parenchyma, reliable homeostasis ensured by the differentiated mode of laser exposure taking into account a type of transected renal tissue.
4 cl, 3 ex
SUBSTANCE: transurethral bladder resection enables the exposure of tumour bed tissues to pulse laser light of wave length 970 nm and emitting power from 10 to 15 Wt. The exposure involves contacting a light guide to bladder wall wound tissues until visualising the coagulation changed within the contact exposure. That is combined with advancing the light guide spirally from the wound periphery to the tumour bed centre. A method involves improving the therapeutic effect by preventing the tumour recurrences, preventing erythrocyturia and developing complications caused by intraoperative complications, as well as preventing complications caused by the deep thermal exposure on the bladder wall.
EFFECT: improving the oncologic surgical effect is ensured by eliminating the tumour cell migration along the tumour bed vessels by the primary coagulation of the peripheral sections of the treated bed.
3 cl, 3 ex
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
SUBSTANCE: method involves carrying out left-side laparophrenotomy. Esophagus and stomach stump extirpation is carried out. Large intestine is conducted in the posterior mediastinum. Distal end-to-end anastomosis of transplant and the duodenum is created using atraumatic sutures.
EFFECT: enhanced effectiveness of plastic repair in the cases of resected stomach cancer.
SUBSTANCE: method involves carrying out hernia removal in intralaminar way. Posterior longitudinal ligament defect is covered with Tacho-Comb plate after having done disk cavity curettage. Subcutaneous fat fragment on feeding pedicle is brought to dorsal surface of radix and dural sac.
EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications.
FIELD: medical engineering.
SUBSTANCE: device has thread knitted into fabric. Fabric for tamponing wound and removing it by pulling the thread is connected to internal film surface with collagen gel. The film overlaps fabric area and has opening equal to two-lumen draining tube canal connected to external film surface and having one canal longer than the other one. Distal end of the shorter canal is connected to opening in the film and distal end of the longer one is brought outside of its boundary. Proximal ends are connectable to vacuum receiver. Fabric thread is brought to the shorter canal from the internal wall and fixed on the external shorter canal wall.
EFFECT: reliability in stopping hemorrhages and retaining patient mobility.
SUBSTANCE: method involves applying sling urethropexy. Pneumoextraperitoneum is created by means of trocar introduced under the pubis. Then, longitudinal perineotomy and paraurethral tissue dissection is carried out to the right and to the left towards the descending branches of pubic bones to pelvic fascia. The urethra is moved to its left. TVT needle is introduced under descending branch of pubic bone to the right of the urethra. The pelvic fascia is perforated in away that needle tip enters retropubic space laterally with respect to the prostate and in front of the urinary bladder. The needle is brought along the posterior pubic bone surface and exits via abdominal wall outside pulling one end of polypropylene ribbon. The like manipulations are accomplished at the left side to form a loop around the urethra tightly adjacent to bulbocavernous muscles. Final ribbon fixation is carried out after having eliminated the pneumoextraperitoneum and having removed the trocar.
EFFECT: simplified operation; avoided intra- and postoperative complications and recidivation.
SUBSTANCE: method involves evaginating duodenum stump with polypotomy loop into organ wall followed by electric surgical excision.
EFFECT: stable hemostasis; provided aseptic conditions in sealing the stump.
3 dwg 1 tbl
SUBSTANCE: method involves carrying out rein performing pancreaticoduodenal resection. Cholecystoenteroanastomosis is built. Anastomosis application takes place between the right hepatic duct and gallbladder neck near its flexure.
EFFECT: prevented biliary hypertension.
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.
FIELD: medicine, surgery.
SUBSTANCE: the method is applied for the purpose to correct combined deformations of external nose due to oral-vestibular operative access. The method deals with dissecting mucosal membrane and periosteum in oral vestibule followed by separating soft tissues of the upper lip. Then one should perform internal incision along the edge of alar cartilages to connect two incisions together. Then comes final tissue separation at subsequent correction of the shape, size of external nose structures and its septum. The method enables to achieve wide access to all the structures of external nose and provide optimal cosmetic result.
EFFECT: higher efficiency of correction.
FIELD: medicine, urology.
SUBSTANCE: the present innovation deals with affecting the sclera and applying deformation-correcting sutures at the background of medicinal erection. Along lateral surfaces of cavernous bodies symmetrically from both sides one should make incisions of scleral surface layer. Then comes manual derotation, moreover, at the side of derotation incision's lower edge should be shifted downwards and backwards, its upper edge - upwards and to the front, and at contralateral side the lower edge is shifted downwards and to the front, and the upper edge - upwards and backwards. After manual penile derotation one should apply sutures onto the edges of dissected scleral layer in incision area by shifting needle's puncture out towards the side being opposite to shift direction of the lower edge against incision's perpendicular axis. The quantity of incisions should be calculated by the following formula: Q = N/n, where Q - the desired quantity of incisions, N - the angle of total initial rotation, n - the angle of derotation achieved after applying sutures onto the first pair of incisions. The method enables to decrease the risk for development of either new or residual penile deformation in postoperational period.
EFFECT: higher efficiency of correction.
3 dwg, 1 ex