Method for surgical management of aseptic pancreonecrosis

FIELD: chemistry.

SUBSTANCE: invention refers to medicine, namely surgery, and can be used for treating aseptic pancreonecrosis. Intra-organic pulseless pancreatic segments are localised and removed. To cover the pancreas, a greater omentum is incised into two portions - 1/3 from the left and 2/3 from the right up to a base of the greater omentum. Segments with pulse oscillation amplitude not less than 3.0 mm in the left 1/3 of the greater omentum and not less than 2.0 mm in the right 2/3 of the greater omentum are localised. The left portion in the distal segment is anchored with U-sutures to peripancreatic subcutaneous fat, whereas the right portion in the distal segment is anchored to a right hepatic lobe.

EFFECT: method enables arresting the disease progression and preventing infected pancreatic necrosis, improving pancreatic tissue blood supply by detecting the intra-organic pulse, removing all necrotic portions of the pancreas and using the greater omentum to cover the pancreas.

3 dwg, 2 ex

 

The invention relates to surgery, in particular to methods of surgical treatment of aseptic necrotizing pancreatitis.

The known method of surgical treatment of aseptic necrotizing pancreatitis by the method of V. A. Kozlov - "abdominal pancreas" (V. S. Saveliev "Guide for emergency surgery of abdominal organs", Moscow, 1986, p. 367). The principle of operation is that after the mobilization of the pancreas behind her is a portion of the greater omentum on a vascular pedicle, which prevents the flow of fluid in the retroperitoneal space.

The disadvantage of this method is the risk of bleeding; the gland is transformed into a tight biological swab, this will disturb the blood supply to the gland, there is a risk of necrosis with subsequent infection.

Known as a "closed" method of surgical treatment of avascular pancreatic necrosis (see K. D. Toskin "Materials for the study of pancreatitis" synopsis of dissertation Dr. med. Sciences. M., 1968), taken as a prototype and which consists in the shelter of the pancreas all of the greater omentum.

The disadvantage of this method is that for shelter pancreas used the greater omentum without regard to its blood supply and lack of additional blood supply to the liver greater omentum, as violations� liver function in acute pancreatitis occurs in 39%, and hepatic failure with jaundice - in 27% (V. I. Filin Acute diseases and injuries of the pancreas", 1982, pp. 51-52). In addition, in this method, possible false-positive and false-negative results of diagnostic plots of the pancreas to be removed, as they are not defined.

The objective of the claimed invention is to improve the efficiency of surgical treatment of patients with aseptic pancreatic necrosis through the detection and removal of necrotic areas of the pancreas, improve the blood supply to the tissues of the pancreas and liver vessels omentum.

The problem is solved due to the fact that the segments of the pancreas will be removed, determined by the absence intraorganelle pulse. Dissect the greater omentum into 2 unequal parts - 1/3 on the left and 2/3 on the right to the base of the greater omentum. The left 1/3 of the greater omentum with the pulse amplitude of oscillations is not less than 3.0 mm in distal portion hem U-shaped seams to peripancreatic tissue, and the right 2/3 of the greater omentum with the amplitude of pulse oscillations is not less than 2.0 mm in the distal section is stitched to the right lobe of the liver the U-shaped seams.

The use of the claimed invention to detect and remove the necrotic areas of the pancreas, improve Cremona�proposal pancreas and liver due to the use of vessels omentum thereby to stop the progression of the disease and prevent infected pancreatic necrosis.

The inventive method is illustrated by drawings, which depict: Fig.1 - greater omentum is dissected into 2 unequal parts closer to the left edge; Fig.2 - 1/3 omental graft is fixed to the U-shaped seams to peripancreatic tissue; Fig.3 - 2/3 of the greater omentum is fixed to the right lobe of the liver the U-shaped seams.

The inventive method is implemented as follows: after sanation of abdominal cavity measured intraorganic the pulse of the pancreas (for example, by Z. M. Siegal (see Segal, Z. M. "the Phenomenon of vzaimoprevrascheny pulse and continuous intramural blood flow in arteries". Proceedings of the Academy of Sciences of the USSR, Moscow, 1982, pp. 795-799)) and is determined by the absence of a pulse of necrotic areas of the pancreas, the latter is removed, the cavity is drained.

Dissect the greater omentum to the base into 2 unequal parts closer to the left edge (Fig.1). Performed hemodynamic measurements in the greater omentum, identify sites with a better blood supply (on pulse 1/3 of the left edge of the greater omentum, the amplitude of pulse oscillations should be 3.0 mm or more; in 2/3 of the right edge of the greater omentum, the amplitude of pulse oscillations is not less than 2.0 mm). Cover 1/3 of the left edge of the greater omentum pancreas and fix e�about to peripancreatic tissue U-shaped sutures (Fig.2). The remaining 2/3 of the right edge of the greater omentum sutured to the right lobe of the liver is also U-shaped sutures (Fig.3).

Example 1

Patient B., Diagnosis: hemorrhagic pancreatic necrosis aseptic, enzymatic peritonitis, alcoholic hepatitis.

Surgery: laparotomy, intraoperative hemodynamic control, necrectomy of the pancreas, pancreatoscopy, heptamethine, sanitation, drainage of the abdominal cavity.

During inspection of the abdominal cavity in the pelvis and in the subhepatic space is found to 500 ml of sero-hemorrhagic fluid. Last removed by suction apparatus. On the greater omentum places are stearic spots. Biliary tract, without features. The liver is enlarged, rather compact consistency. Revealed omental Bursa, pancreas severely swollen, thickened, dark cherry color all over. On the anterior surface of the pancreas detected foci of necrosis in the amount of 3 irregular shape: a 2.0×1.0 cm; a 3.0×2.0 cm; a 3.0×2.5 cm, the pulse Amplitude of oscillations in intact pancreatic tissue was 2.5 mm. the Amplitude of pulse oscillations of " no necrotic areas. Lesions removed method digitalise, cavity drained.

The greater omentum is longitudinally cut into two unequal flap closer to the left edge to the ground. When �hemodinamically study, 1/3 of the left edge of the greater omentum revealed the amplitude of pulse oscillations 4.5 mm and 2/3 of the right edge of the greater omentum - 2.5 mm. the Pancreas is covered by the left flap of the greater omentum; commit its U-shaped catgut sutures to peripancreatic tissue. The right 2/3 flap of the greater omentum sutured to the right lobe of the liver.

The postoperative period was uneventful. The patient is examined after 1 year, the condition is satisfactory, no complaints.Biochemical analyses of blood and urine without pathology.

Example 2

Patient X., Diagnosis: Hemorrhagic pancreatic necrosis aseptic, enzymatic peritonitis, alcoholic hepatitis.

Surgery: laparotomy, intraoperative hemodynamic control, necrectomy of the pancreas, pancreatoscopy, heptamethine, sanitation, drainage of the abdominal cavity.

During inspection of the abdominal cavity in the pelvis and in subhepatic space up to 1500 ml of sero-hemorrhagic fluid. Last removed by suction apparatus. On the greater omentum places are stearic spots. Biliary tract, without features. The liver is enlarged, rather compact consistency with a yellowish color. Revealed omental Bursa. The pancreas is severely swollen, compacted, dark cherry color all over. On the anterior surface of the pancreas detected foci of necrosis in the amount of 4 irregular�Oh shape: a 1.5×1.0 cm; A 2.0×1.5 cm; 2,0×2.5 cm; a 2.0×2.0 cm, the pulse Amplitude of oscillations in intact pancreatic tissue was 3.0 mm. Intraorganic pulse no necrotic areas. Lesions removed method digitalise, cavity drained.

The greater omentum is longitudinally cut into two unequal flap to the base closer to the left edge. In the hemodynamic study, 1/3 of the left edge of the greater omentum revealed the amplitude of pulse oscillations 3.5 mm, and 2/3 of the right edge of the greater omentum - 2.0 mm. the Pancreas is covered by the left flap of the greater omentum; commit its U-shaped catgut sutures to peripancreatic tissue. The right 2/3 flap of the greater omentum sutured to the right lobe of the liver.

The postoperative period was uneventful. The patient is examined after 1 year, the condition is satisfactory, no complaints. Biochemical analyses of blood and urine without pathology.

Method of surgical treatment of aseptic necrotizing pancreatitis, including shelter pancreas gland on a vascular pedicle, wherein the detected portions of the pancreas with no intraorganelle pulse and remove them, to shelter the pancreas dissect the greater omentum into two parts, 1/3 on the left and 2/3 on the right to the base of the greater omentum and the detected portions with the amplitude of the pulse OSC�of lazy not less than 3,0 mm in the left 1/3 of the greater omentum and not less than 2.0 mm in the right 2/3 of the greater omentum, while in the left part distal portion hem U-shaped seams to peripancreatic tissue, and the right to distal portion is stitched to the right lobe of the liver.



 

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