The method of surgical treatment of a pancreatic pseudocyst of the pancreas
(57) Abstract:The invention relates to medicine, surgery may be used in the surgical treatment of pancreatic pseudocyst of the pancreas. Execute access to the "mediastinum" retroperitoneum. The puncture is carried out in the area of the rib-muscle angle to the left. When advancing the needle perform Gidropark tissues. After the puncture, drain the pancreatic pseudocyst. The method can reduce the mortality in the treatment of retroperitoneal pancreatic a pancreatic pseudocyst. 2 Il. The present invention relates to medicine, namely to surgery, and can be used in the treatment of a pancreatic pseudocyst of the pancreas localized in the region of the body, tail and retroperitoneal cellular tissue space on the left.An increase in the frequency of cases the diagnosis of a pancreatic pseudocyst due to destructive processes in the pancreas, associated, first, with success in the treatment of severe forms of acute pancreatitis and, secondly, with the introduction of the General practice sophisticated imaging techniques (sonography, x-ray and magnetic resonance tomography). When destructive form of acute pancreatitis education pancreatic pseudocyst is observed in 50-55% of cases (Grace R. A. spleen, the splenic angle of the colon, the upper pole of the kidney (owl Century. And. , Kostyuchenko A. L. Emergency pancreatology. - S.-Petersburg, 1994).It is known that in the unformed wall of the pseudocyst and no tendency to spontaneous reduction, apply the following methods of operation: 1) external drainage, including laparotomy, opening the cyst, the revision of the cavity, the establishment of the drainage system (Corigin A. A., Nechaev E. A., Smirnov, A. D. Surgical treatment of cysts of the pancreas, - S. Petersburg, 1996); 2) minimally invasive percutaneous drainage, including puncture and holding catheters under ultrasound and x-ray television control with subsequent readjustment of the 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. Musayev and other 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 chirurgiens access and even more so when laparotomy may get infected content from abnormal retroperitoneal concentrations in the free abdominal cavity with subsequent development of peritonitis.As the prototype is taken treatment of cysts of the pancreas, including puncture, contrast and drainage under ultrasound and x-ray control by means of transluminal access point located in the region of the left triangle Lesgaft-Grunfeld on the level of the first lumbar vertebra. In this way the drainage device spend ventral 0.5 - 2.0 cm outwards from the side surface of the vertebra (Pogrebnyakov C. Y., Lobanov S. L. Patent of the Russian Federation, MKI A 61 B 17/00 N 2098145).However, along with the indisputable advantages (extraperitoneal conducting catheter exception of injury to the kidneys, aorta, celiac plexus) method, in our opinion, has several disadvantages: a small angle between the extreme positions a puncture needle, limited to one side of the transverse process of the vertebra and on the other hand kidney, not to drain not formed a pseudocyst with localization in parabolicsar and parrinello tile shall I puncture needle along the vertebral body; acoustic shadow from the transverse processes of the vertebrae difficult ultrasonic visualization; due to the severity of the condition is not always the patient may take the position lying on his stomach; the catheter is fixed to the skin on the back that is not comfortable for the patient during long-term treatment.The aim of the invention is to improve the treatment results of patients with destructive pancreatitis, reducing mortality in these patients.Task: without risk of damage to the spleen, kidney, splenic angle of the colon to get the opportunity extraperitoneal access for percutaneous drainage of retroperitoneal pancreatic a pancreatic pseudocyst under echographic control.The essence of the method lies in the fact that remove tissue debris and subsequent cavity sanation a pseudocyst is performed by percutaneous drainage under ultrasound and x-ray television control. When this needle channel used in future to conduct drainage catheter is formed in the left rib-muscle angle between the XII rib and the outer margin of the Sacro-spinalis muscles), and dorsal Caudalie from the lower pole of the spleen and dorsal and cranial from vetsa pancreatic pseudocyst, due to the destructive process in the pancreas and the structural features of the lateral wall of the fiber space, where a relatively thin fascia contributes to the spread of the inflammatory process upwards, downwards and outwards (Korte, 1923).The method is as follows. The patient laid on the floor right side, giving a stable position by the platen beneath the lumbar region. Produce intravenous anesthesia. The ultrasonic sensor is installed in the region of the rib-muscle angle and choose the angle of the needle, which needle track passes between the lower pole of the spleen and the upper pole of the kidney, and the movement of the needle 1-2 mm in diameter is controlled by ultrasound. To avoid damage to the organs located in the immediate vicinity laid needle track during the advance of the needle, apply Gidropark tissues (e.g. 0.25% solution of novocaine) that keep track of sonography. After insertion of the needle into the cavity of a pseudocyst aspiritual its contents in this volume, to reduce the pressure in the cavity up to 200-250 mm of a water column, then fill the cavity with water-soluble contrast medium induced by the drug (for example, 40-50% of the unaudited hold the string of Lundequist, the direction of holding the strings regulate the inclination of the needle and control radiographically. The string can be positioned in various ways: by the tail and body of the pancreas, in front of perirenal or rear parabolicheskoi fiber space. The string in the specified direction down the catheter, the diameter and length of the perforated end of the target individually. Drainage is carried out or fractional permanent irrigation zone of destruction antiseptic solution.The main distinctive feature of the proposed method in the new access, allowing to drain from one position parametron, parabolon and actually retroperitoneal tissue or "mediastinum" retroperitoneum (N.And. Pirogov). Injuries located in the immediate vicinity of the puncture channel solid and hollow organs warn constant ultrasonic visual control over the movement of the needle and the receiving layer exocontralto getroproperty be in the direction of needle tissue.Example. Patient P., aged 47, N history of 1597. He enrolled in the Department of surgery of the liver and pancreas of the Republican centre for functional surgery is an increase of 38 days, ill acutely, the cause of the disease with nothing to link. Was hospitalized to the Central district hospital where diagnosed diabetes mellitus, and then transferred to the Republican Oncology center to clarify the nature of a lesion in the left upper quadrant, where a CT scan revealed "space-destructive process of the pancreatic tail" When entering RZQHG in the left upper quadrant is palpated painful, dense formation size 610 cm, spleen enlarged. Ultrasound revealed a liquid, the formation of irregular shape 10117 cm, with thin walls, heterogeneous echogenicity content located in the retroperitoneal space, between the kidney, enlarged spleen, the stomach and the splenic angle of the colon. 29.11.96 made drainage of a pseudocyst extraperitoneal access needle track selected when the sonogram, between the upper pole of the kidney and splenic angle poperechnopolostah intestine, with hydropiperoides tissues with 0.5% solution of novocaine, with x-ray television control installation of the catheter. Aspirated 400 ml of hemorrhagic detachable fabric detritus, with amylolytic activity 379,9 g/l/h, without signs of inficon is possessed; continued treatment on an outpatient basis. After 15 days in the control fistulografii identified plagiogranites numb in parallon, under x-ray television control carried out, the location of the working end of the catheter. 15.01.97 catheter removed, ultrasound signs of cysts in the pancreas was not detected (see Fig. 2). After 6 months the patient has no complaints, in the abdominal cavity revealed no pathology.When using the proposed method is expected to decrease the development of septic complications and mortality in patients with pancreatic pseudocyst by preventing laparotomy. The method of surgical treatment of a pancreatic pseudocyst of the pancreas, including puncture extraperitoneal access and drainage, characterized in that to provide access to the "mediastinum" retroperitoneum, fiber space parabolon and/or parametron, the puncture is carried out in the area of the rib-muscle angle to the left, and at the same time, when the movement of the needle, perform Gidropark tissues.
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