The method of surgical treatment of infected pancreatic a pancreatic pseudocyst of the spleen
(57) Abstract:The invention relates to medicine, namely to surgery, and can be used in the treatment of the pancreatic pancreatic pseudocyst and abscess of the spleen. Remove purulent-necrotic content saving the parenchyma of the spleen under the control of ultrasonic tomography. Using percutaneous drainage by needle channel in the intercostal space. Intercostal period corresponds to the lesion. The method allows to speed up the process of restitutie foci of pancreatic destruction. 2 Il. The invention relates to medicine, namely to surgery, and can be used in the treatment of the pancreatic pancreatic pseudocyst and abscess of the spleen.With the introduction into clinical practice the latest diagnostic equipment (ultrasound, x-ray, magnetic resonance imaging) with the opportunity to identify and correct interpretation of such complications destructive pancreatitis as intraorganic the pseudocyst and abscess, previously considered rare (A. A. Kuragin, E. A. Nechaev, A. D. Smirnov Surgical treatment of cysts of the pancreas. - S.-Petersburg, 1996; Blandino-A; Scribano-E; Aloisi-G; Visalli-C; Pandolfo-I // Abdom-Imaging. 1996 Jan-Feb; 21(1):the eye may remain undiagnosed (note surgeons focused on the elimination of pancreatic accumulations in the retroperitoneal peripancreatic tissue), to exacerbate the underlying disease course, to cause the development of peritonitis due to rupture of the capsule of the spleen and bleeding into the abdominal cavity.There is a method of surgical treatment of abscesses of the spleen - splenectomy (I. Littmann. Operative surgery.- Budapest, 1982), involving laparotomy in the left hypochondrium, the mobilization of the gastro-splenic and pancreatic-splenic ligament with legirovaniem and the intersection of the splenic artery and vein with subsequent removal of the spleen.However, in the presence of peripancreatic inflammatory infiltrate, due to the flow of destructive pancreatitis, any available laparotomic access to the gastro-splenic and pancreatic-splenic cords is extremely difficult for the surgeon and traumatic for the patient. Impractical seems laparotomy and when a patient with pancreatic abscess of the spleen, there are some positive trends in the treatment of peripancreatic lesions destruction percutaneous minimally invasive methods, and the latter is increasingly used in the last decade. You should not neglect also the occurrence of fulminant sepsis after splenectomy the Finance through the bed of the resected ribs above the zone of localization of abscess after diagnostic puncture and confident of obtaining pus (C. I. Filin, A. L. Kostyuchenko. Emergency pancreatology. -S.-Petersburg, 1994).The disadvantages of this organ-preserving method are its invasiveness, risk of developing pleural, pulmonary complications due to the proximity of purulent and significant limitations of the respiratory excursions of the chest.The development of precision technology percutaneous drainage of abdominal pathological lesions under ultrasound, x-ray television and intercomputer control has led to a revision of the indications for laparotomy with limited liquid accumulations in the liver, the pancreas, the various divisions of the abdominal cavity (Y. A. Nesterenko, S., shapovalianz, S. C. Mihalyov, M. R. Imanaliev. Echotomography in the diagnosis and treatment of acute pancreatitis.- M , 1995; A. N. Lots, I. I. a), G. H. Musaev et al. Destructive forms of pancreatitis: status and future challenges // minimally Invasive interventions in surgery. M., 1996. C. 221-226; B. S. Briskin, A. M. Minasian, M. A. Vasiliev, M., Barsukov. Percutaneous minimally invasive interventions under the control of sonography in abscesses of the abdominal cavity // minimally Invasive interventions in surgery.- M., 1996. C. 208-211).For the prototype declared sposored control of the ultrasonic scan. (Janssen-J; Johanns-W; Greiner-L Non-operative management of pancreatitis with splenic involvement // Z Gastroenterol. , 1997 Aug; 35(8): 621-5). Treatment method in this method is the following: after diagnostic ultrasound produce local anesthesia and sighting fine-needle puncture of the pseudocyst with simultaneous aspiration.However, this method is acceptable only when uninfected pseudocyst, not containing large fragments of tissue debris, blood clots.The purpose of the invention is to reduce mortality in patients with destructive forms of pancreatitis, accompanied by the formation of infected pancreatic pseudocyst of the spleen.The task of the invention is to speed up the process of restitution of pancreatic lesions destruction by eliminating pancreatic abscess of the spleen percutaneous access with minimal trauma to the patient and to reduce the likelihood of fatal complications, frequent at the traditional methods of surgical treatment of these patients.The essence of the method lies in the fact that the removal of tissue debris, preserving unchanged parenchyma and subsequent reorganization of the abscess cavity is the first channel, used in future to conduct drainage catheter is located in the intercostal space on the anterior or sredneoblastnoy line depending on the constitutional features of the patient, size of the spleen and localization of the nidus in it. Consider acceptable, if topographic-anatomical features not otherwise allow the carrying out of drainage catheter through the rib-diaphragmatic sinus at its lowest point.The method is performed in the following sequential actions. Patient is placed on the right side, creating a stable position with a roller under the back and rump. Perform intravenous anesthesia. After processing the surgical field during an ultrasound scan of the intercostal spaces on the left selects the trajectory of the needle channel; it must be on the shortest path from the skin to the abscess and not intersect the rib-diaphragmatic sinus. However, the latter condition is relative, as our experience shows. Under ultrasound guidance into the cavity of the abscess is injected on the upper edge of the underlying ribs puncture needle with a diameter of 1.0 to 1.5 mm, aspirinum 10-20 ml content, the needle is injected angiographic conductor, p is th cavity, it is especially important to consider in the event of involuntary conduct of the catheter through the pleural sinus. The catheter aspiritual contents and wash out the cavity of the abscess solutions antiseptical under ultrasound control, confirming the correct location of the catheter and the absence of any bleeding. In the event of a catheter through the pleural sinus, the catheter is injected 40-50% solution of radiopaque substances under x-ray television control to ensure the absence of getting the contents of an abscess in the free pleural cavity. In the future perform fractional irrigation of the abscess cavity with antiseptic solution through the catheter. Completeness of restoration and the process of reduction of necrotic cavity in the spleen track when fistulografii.A distinctive feature of this method of treatment of pancreatic abscess and pancreatic pseudocyst of the spleen is the use of the drainage system, conducted by puncture channel in the intercostal space, which allows without laparotomy, with preservation of the parenchyma of the spleen to carry out reorganization of the nidus.Quickly achieved positive clinical effect remains spleen, sokrawenija in the Department of surgical leczenie pancreas Republican center for functional surgical gastroenterology, 26.06.98 Upon receipt complained of pain in the upper abdomen, recurrent vomiting, increased body temperature to febrile digits. Sick with 14.05.98, about suppurative complications of acute destructive pancreatitis was operated with external drainage stuffing bags and outer cholecystectomia. Admission is palpated in the epigastrium infiltrate 6X10 cm, in the right hypochondrium - fistulous opening with bile discharge, in the left hypochondrium - fistulous opening with purulent discharge. Ultrasonography revealed the presence of a liquid cavity under the capsule of the spleen on its outer surface dimensions HH cm with heterogeneous echogenicity content. 27.06.98, under intravenous anesthesia after sighting the puncture in the 10th intercostal space in peredatochnoi line during ultrasonic testing of installed catheter. The patient was treated with discrete washing the cavity with antiseptic solutions with sonographic monitoring of its condition and size. After 18 days after the inspection fistulography that upheld the restitution of the cavity, and in the absence of a detachable catheter was removed. The patient was discharged in satisfactory condition 20.07.98, When the control ultrasonic Isleta of the proposed method is expected to reduce the incidence of septic complications in patients with destructive pancreatitis in the prevention laparotomy about the infected pancreatic pseudocyst of the spleen and to reduce mortality in this group of patients. The method of surgical treatment of infected pancreatic a pancreatic pseudocyst of the spleen, including the removal of necrotic content with preservation of the parenchyma of the spleen under the control of the ultrasonic tomography, characterized in that the removal of necrotic content is performed by percutaneous drainage by needle channel in the intercostal space, corresponding to the lesion.
SUBSTANCE: method involves conducting bougie through the liver. Flexible tube is attached to its end and set in bile ducts. Flexible radio-opaque conductor is introduced through the flexible tube. The tube is removed. Draining tube is introduced along the conductor from porta hepatis to its diaphragmatic surface into the ducts to be drained.
EFFECT: reduced risk of traumatic complications.
SUBSTANCE: method involves puncturing pyogenic abscess cavity under ultrasonic control with draining tube left therein. Laparoscope connected to monitor unit is introduced into abscess cavity. One of introduced drains is set in upper point of the cavity and the other one in lower point. The abscess cavity is filled with ozonized solution to 2/3 of its volume and bubbled with ozone-oxygen mixture during 2-3 min changing the solution until it becomes transparent. The emptied cavity walls are treated from distance of 3-4 cm with laminar airflow heated to 38-40°C under pressure of 1-1.5 atm during 2-3 min. Next to it, the cavity walls are irradiated from distance of 2-3 cm with non-coherent red light during 2-3 min per each area.
EFFECT: improved safety conditions and healing quality.
FIELD: medical engineering.
SUBSTANCE: device has suction tube having lateral openings and irrigation tube. The irrigation tube is connected to jet-action atomizer. The atomizer is hollow collapsible cylinder with holes. Ultrasonic radiator having conductor to ultrasonic frequency oscillator is available in the cylinder. The radiator and conductor enable one to introduce ultrasonic oscillations into antiseptic solution.
EFFECT: enhanced effectiveness of treatment.
SUBSTANCE: method involves puncturing pyogenic cavity with trocar having blunt obturator via skin incision made outside of abscess boundary having length equal to arthroscope diameter. Then, arthroscope is introduced and the cavity is filled with physiologic saline. Pyogenic cavity revision is carried out under arthroscope control, irrigation cannula is set, constant water medium is created. Arthroscopic mill on shaver handle is introduced via another skin incision. Non-viable tissues are removed with stage-by-stage hemostasis using endocoagulator. The cavity is healed. Perforated draining tube is set under arthroscope control. Tube ends are brought out through pierces outside of the cavity and sutured to skin. Active suction of wound exudates is carried out using closed vacuum drain system in postoperative period. The drainage is removed when cleaning the wound from wound microflora and single sutures are placed.
EFFECT: enhanced effectiveness of treatment.
FIELD: medicine, abdominal surgery.
SUBSTANCE: the present innovation deals with treating patients in case of destructive forms of pancreatitis. One should lance a gastro-colic ligament, mobilize splenic and hepatic angles of large intestine, tighten a middle colic artery, descend mesenteric root cross-sectionally against a colon, dissect parietal peritoneum along the upper and lower edges of pancreas to withdraw it into abdominal cavity, remove necrotized tissues. Then one should apply a rubber balloon with drainage tubes along its upper and lower edges into omental cavity: one balloon's end should be withdrawn through median wound, another one - through contra-aperture being 5 cm below a costal arch along median axillary line. The method suggested enables to form adequate access to patient's pancreas.
EFFECT: higher efficiency of drainage.
6 dwg, 1 ex
FIELD: medical engineering.
SUBSTANCE: device has liquid-permeable porous lining that is to be placed on or in a wound, flexible plastic film having a set of holes distributed over its surface, liquid-impermeable film napkin and connection means. The porous lining has foamed polymer material having interconnecting cells. The plastic film makes contact with porous lining surface and is between wound surface and the lining when used. The film napkin is placed above the porous lining and is sticky along its perimeter to provide sealing in skin area surrounding the wound. The connection means passes through the film napkin and communicates to porous lining via liquid flow for making connection to negative pressure source for stimulating fluid flow discharged from the wound. Another embodiment has removable wound bandage usable in particular for treating large wounds requiring draining fluids. It has the first porous lining, the second porous lining, elastomer envelope, film napkin and tubular connection means. The first liquid-permeable porous lining contacts the wound and has foamed lining having foamed material based on polymer built of interconnecting cells and isolated transverse holes. The elastomer envelope has the first and the second sheets of elastomer film soldered along their periphery and enveloping said foamed lining. Each of the first and the second elastomer film sheets has spaced-apart holes. The holes in the second sheet are justified with said spaced-apart holes in the first sheet. The second liquid-permeable porous lining is to be placed under the first porous lining. It has foamed polymer material having interconnecting cells. The liquid-impermeable film napkin is placed above the second porous lining. The first porous lining is placed above the wound. The film napkin is sticky along its perimeter to glue the napkin to skin area surrounding the wound. The tubular connection means passes through said film napkin and communicates to porous lining via liquid flow for making connection to negative pressure source for stimulating fluid flow discharged from the wound. The third embodiment has the first elastomer film sheet having spaced-apart holes deviated from spaced-apart holes in the foamed lining. The second elastomer film sheet has spaced-apart holes adjusted to the spaced-apart holes in the foamed lining.
EFFECT: simplified usage; accelerated wound healing.
15 cl, 3 dwg
FIELD: medicine, surgery.
SUBSTANCE: one should perform decompression of Wirsung's duct with the help of silicone instrument or catheter in case of pancreatogastrostomy in the course of pancreatoduodenal resection. Moreover, the above-mentioned instruments should be fixed in anastomosis with one of the sutures in internal row, their free ends should be loosely located in the stomach and tightened to caprone ligature to be then withdrawn through patient's nose. In 7-10 d either silicone instrument or catheter should be removed due to pulling by caprone ligature. The innovation enables to decrease the risk in the failure of pancreatogastroanastomoses and post-operational pancreatitis.
EFFECT: higher efficiency of draining.
FIELD: medicine, surgery.
SUBSTANCE: at the end of the main stage of operation conducted one should perform paravertebral Novocain blockade by puncturing the sheath of m.erector trunci, the drainage should be introduced towards lateral edge of m.ilipsoas through paracentesis of lumbar area being about 1-2 cm above ilium's ala at the line made via the end of the 12th rib vertically up to ilium's ala. Retroperitoneal space should be, also, drained. The innovation enables to prevent purulent-septic complications and decrease the pain.
EFFECT: higher efficiency.
1 dwg, 2 tbl
FIELD: medicine, obstetrics, gynecology.
SUBSTANCE: uterine cavity should be drained in the course of operation, moreover, irrigator's distal end should be withdrawn through operation wound at anterior abdominal wall, and 2 h after the end of operation uterine cavity should be washed through irrigator with 400 ml of cooled 0.06%-sodium hypochlorite solution at perfusion rate being 200 ml/h, 6 times every 12 h up to 3-4 d; after each perfusion one should introduce 1 g kanamycin directly into uterine cavity, moreover, in case of availability of bacterioid and/or anaerobic flora in uterine cavity according to the results obtained due to pre-operational antibioticogram one should add 100 ml 3%-hydrogen peroxide solution into perfusion solution. The present innovation enables to efficiently sanitize uterine cavity due to intrauterine injection of antibiotics by taking into account antibioticogram performed at all stages of operative treatment.
EFFECT: higher efficiency of prophylaxis.
1 cl, 2 ex
FIELD: medical engineering.
SUBSTANCE: device has lateral holes and is manufactured from absorbable material like polydioxanon. The holes are diametrically arranged in two rows along the whole tube length in chessboard order in the first embodiment of the invention. The absorbable material of polydioxanon is manufactured as threads arranged as reticular mesh grid structure of 12-20 u/cm in building tube walls.
EFFECT: eliminated occurrence of pyo-inflammatory complications.
2 cl, 2 dwg