The method of treatment of acute pancreatitis

 

(57) Abstract:

The invention relates to medicine, surgery may be used in the treatment of acute pancreatitis. After opening the abdominal cavity of the stuffing bags form an isolated cavity. Fill the cavity with a solution of protease inhibitors. Through the solution process the pancreas and retroperitoneal tissue by low-frequency ultrasound. The treated liquid is replaced by a solution of 5-fluorouracil with antibiotics. Re affected by ultrasound. The procedure is repeated 1 times a day for 3 to 5 days. The method allows to reduce time of treatment of acute pancreatitis due to the intensification of drug and physical effects.

The invention relates to medicine, namely to surgical treatment of pancreatic necrosis.

The prototype for the invention gave the following two methods of treatment of acute pancreatitis (Kozlov C. A., Starodubov Century. And. Abdominal pancreas, bursoomentoscopy and local hypothermia in the treatment of acute pancreatitis. - Sverdlovsk: Publishing house of the Ural. University, 1988.- S. 109-118. USSR author's certificate N 1447379 class. A 61 N 5/02).

However, these methods do not provide the possibility of mnogokratno postoperative period without re-operation and do not provide effective removal of effusion and detritus.

The purpose of the invention is the reduction of treatment time due to the intensification of drug and physical effects on the pancreas and retroperitoneal tissue, more effective removal of exudates and debris, reducing the severity of purulent complications.

Goal is achieved by repeated application of energy low-frequency ultrasound as during surgery and in the postoperative period to create in the area of the pancreas and retroperitoneal fat high concentrations of protease inhibitors, cytostatics, antibiotics order inactivation and suppression of the synthesis of enzymes, prevention of severe septic complications, as well as by means of acceleration of rejection of effusion and detritus.

The method is as follows.

After laparotomy widely dissect the gastrocolic ligament, assess the condition of the pancreas, retroperitoneal tissue. With extensive destructive process dissect the parietal peritoneum on the lower and upper edge of the pancreas, it is widely mobilize with revision retroperitoneal tissue, remove loose necrotic tissue, open ulcers. Retroperitoneal tissue is washed with an antiseptic solution. Raskovoy bag is formed cavity, isolated from other parts of the abdomen. In the formed cavity fill in a solution of protease inhibitors, and through him spend processing the pancreas and retroperitoneal tissue energy low-frequency ultrasonic waves. Waste fluid is removed and replaced with a solution of 5-fluorouracil with antibiotics. Again conduct ultrasonic treatment of the pancreas and retroperitoneal tissue. Under the pancreas fail several wide latex strips and drainage tubes. Formed cavity fill several such strips and levamisole ointment. Low frequency ultrasonic treatment of the pancreas and retroperitoneal tissue through medicinal solutions repeat 1 time per day for several days.

Example. Patient L., aged 47, was admitted to the surgical Department with complaints of sharp pain in the upper abdomen, repeated vomiting with an impurity of bile, severe weakness. Sick for 2.5 days, when there was a girdle pain epigastric pain. When entering a serious condition. Subikterichnost sclera, skin redness. Pulse 112 beats./min, blood pressure 100/60 mm RT.article Tongue dry. Belly symmetrically swollen, palpation e.g. the data.

Diagnosis: acute destructive pancreatitis, pancreatic peritonitis, intoxication.

After preoperative preparation of the patient is taken to surgery urgently. During inspection of abdominal cavity organs found in the abdomen about 1200 ml unclear hemorrhagic effusion with a brownish tinge. Gallbladder and the choledoch without visible pathology.

On the big and small gland at the root of the mesentery of the small intestine and the mesentery of the transverse colon pockets of Stonecross. Widely dissected the gastrocolic ligament. In the cavity stuffing bags to 200 ml of hemorrhagic effusion, on the walls of the pockets stefanakos. Pancreas and retroperitoneal tissue dark color. On the lower and upper edge of the pancreas dissected, parietal peritoneum, pancreas is mobilized from the tail to the neck. When the audit of the retroperitoneal tissue found that it imbibition hemorrhagic exudate, infiltrated, contains many steatocranus from 0.3 to 0.5 cm, which sometimes merge into a continuous field of necrosis up to 2.5 cm in diameter and contain a pasty mass. Method digitalise removed most of the large areas of necrosis. Retroperitoneal tissue washed 0, illinoi the peritoneum of the anterior abdominal wall. In the packing bag, isolated from the other departments of the abdominal cavity was filled with 350 ml of physiological solution with 25000 IU kontrikala, and through him spent the irradiation of the pancreas and retroperitoneal fat low frequency ultrasonic energy at a dose of 1.5 s/cm2the apparatus of URSC-7H-18. The spent solution was removed and it was replaced by the same volume of saline solution with 250 mg of 5-fluorouracil and 500 mg of ampicillin sodium salt, again handled gland and tissue by ultrasound at the dose of 1.5 s/cm2. Under the pancreas has failed 3 wide latex strips and 3 silicone tubes with a diameter of 0.8 cm, Isolated cavity stuffing bags filled 6 the same stripes and levamisole ointment. Laparotomic wound sutured to the selected strips and tubes.

After surgery, the patient was placed in the intensive care unit, where they spent the antibiotic therapy and infusion therapy, was resolved water and electrolyte balance and acid-base balance. Through the left tube lavage was performed retroperitoneal fat and stuffing bags of 0.02% chlorhexidine.

After 18 h after the operation of the cavity stuffing bags removed 6 of latex strips and remains levomekol ointment, it Salim URSC-7H-22. This solution was replaced with the same volume of saline solution with 250 mg of 5-fluorouracil and 500 mg of ampicillin sodium salt and was again irradiated with ultrasound at a dose of 1.5 s/cm2. The solution was removed, packing bag, introduced 6 latex strips and levamisole ointment.

This manipulation was repeated 1 time per day for 4 days, washing away every time a large amount of detritus. Tubes and strips remained in the retroperitoneal tissue and around the pancreas for 2.5 weeks, they were separated muddy serosanguineous fluid with detritus. 18 days after the operation in connection with the scarce number of discharge tubes and strips removed. Treatment continued for 17 days, during this time, the cavity slept and closed. In a satisfactory condition and was discharged for outpatient treatment 35 days after surgery. Low-frequency ultrasonic energy and medicinal substances are fed directly to the pancreas and retroperitoneal tissue that provides deep penetration in their diseased tissue with impaired microcirculation, has antifermentny and anti-inflammatory, stimulates regeneration processes. Through the formed cavity is provided free outflow wipotec in the retroperitoneal tissue, that shortens hospital stay.

Thus, during the first operation creates a controlled open drain cavity above the pancreas and retroperitoneal tissue, allowing for a long time in the postoperative period to re-treatment of the affected tissue by the energy of low-frequency ultrasound and medicinal substances without re-operation, as well as providing effective removal of effusion and detritus.

After a comparative analysis, by applying the proposed method in patients with severe pancreatitis, marked by its economic efficiency. Inpatient treatment of patients decreased on average by 8, 9 bed days.

The method of treatment of acute pancreatitis through surgery, characterized in that, to reduce treatment time due to the intensification of drug and physical impact and more effective removal of effusion and detritus, after opening the abdominal cavity of the stuffing bags form an isolated chamber, fill it with a solution of protease inhibitors, and through him spend processing the pancreas and retroperitoneal tissue discocyte the frame of ultrasound, a similar procedure is repeated 1 times a day for 3 to 5 days.

 

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