The method of treatment of pancreatic necrosis

 

(57) Abstract:

The invention relates to medicine, surgery and can be used in the treatment of severe necrosis of the pancreas. Perform decompression of the pancreas. On the anterior surface of the pancreas pierce the capsule segments on the entire thickness. Placed on the perforated surface of the gland sorption drainages. The method allows to reduce the intraductal pressure in the pancreas.

The invention relates to medicine, namely to surgery, and can be used in the treatment of severe necrosis of the pancreas.

Acute intraductal hypertension resulting from sudden barriers to the outflow of pancreatic secretions, is a trigger of acute pancreatitis. Acinar cells under conditions encountered edema and high vnutridiskovogo edema experiencing hypoxia, which is the reason for their necrosis.

Known method of decompression of the pancreas when it is necrosis, which consists in the transverse and longitudinal dissection of the pancreas with the intersection of the transverse and the longitudinal direction of the main pancreatic duct (Sazhin Century the I, 1994, No. 3, S. 56-59; ed.St. N 89636 from 14.12.89 year).

The disadvantages of this method is the formation of chronic pancreatic fistula, the invasiveness of the surgery.

The objective of the invention is to reduce high vnutridiskovoe pressure in the pancreas, reduce the burden on regional lymphatic apparatus cancer, to improve its drainage function.

The method is as follows.

Verkhnesadinsky laparotomy. To a considerable extent dissected the gastrocolic ligament to access the pancreas. After examining and ascertaining hemorrhagic or mixed necrosis of the pancreas over the entire area of the front surface of the produce puncturing the capsules of its segments on the entire thickness of the gland device representing the plate size 2.5x3.5 cm with fixed thereto a thin needle with a length of up to 3.5 cm rows at a distance of 5 mm from each other. Then, on the front surface of the pancreas fit sorption drainages, representing a vessel filled with carbonaceous mineral sorbent SUMS-1. Despite the swelling peripancreatic tissue of the peritoneum on it, not dissected and abdominal" cancer is not possible. After 3 days proizvoditelnee drains into the cavity of the lesser omentum is installed drain pipe of small diameter, which is removed when there is no discharge from it.

Thus liquidated nutricology swelling that prevents further development of necrosis of the pancreas and with sorption drainage performing "prosthetic" function of regional lymph collectors, is unlocking the drainage function of these collectors, which also helps to decrease swelling in the lobules of the pancreas.

Clinical example

Patient K., 74 years old, was admitted to the clinic of General surgery 06.12.96, 0 h 30 min with complaints of acute pain in the epigastrium and left hypochondrium, nausea, repeated vomiting.

The pain came 04.12.96, 17 hours after ingestion of fatty foods. Their intensity grew, joined vomiting. In September 1991, he suffered a stroke. Was ill with diabetes. When entering a serious condition, clear consciousness, the active position. The skin slightly icteric. AD - 240/130 mm RT. Art., pulse 120 beats per minute, rhythmic, satisfactory filling. Belly swollen, painful to palpation in the region of the pancreas. The pulsation of the aorta in the epigastric pain is not felt. The symptom of concussion peritoneal negative. Intestinal peristalsis is not listens to the Ubin - 57.2 mmol/l, sugar - 11 mmol/l, blood urea - 12.6 mmol/l

An. urine: beats. weight - 1022, protein - 0,132, sugar 2%, acetone +, diastasis - 2024 unit, leukocyte - 6 in the p/SP.

Laparoscopy in abdominal hemorrhagic effusion. The gastrocolic ligament infiltrated hemorrhagic fluid. On the seal plaques of stefanakos.

The diagnosis of hemorrhagic pancreatic necrosis. Within 12 hours was carried out intensive detoxification therapy without noticeable effect. Risk factors for Ranson > 5.

06.12.96, 14 hours operation. Verkhnesadinsky laparotomy. In the abdominal cavity to 150 ml of hemorrhagic fluid. Plaques of steatocranus large omentum. Cut the gastrocolic ligament.

Pancreas throughout purple-black color. In the head section of obvious necrosis 3x3 see the Gall bladder is moderately tense, without concretions. With needles made needle decompression parenchyma mud in its entirety. On gland laid two sorption drainage (SUM-1). The generated box in the gastrocolic ligament by filing the edges of her slit to the top right corner of the wounds of the abdominal wall. Layered sutures in the wound of the abdominal wall.

During the settlement of the RT.art., the pulse was 120 / min, rhythmic. Belly swollen. Peristalsis no. In the blood increased the number of cells to 18.5109increased shift formula of white blood: p/I - 14;/I - 77, l - 3, m - 6. Normalized content of bilirubin and blood sugar. The quantity of urea - 8.5 mmol/l, total protein - 50.2 g/l, diastasis urine - 8-32 unit

09.12.96, relaparotomy. In the cavity of the lesser omentum to 30 ml of liquid brown color, odorless. Sorption drains swollen, soaked with liquid brown, removed. The pancreas throughout the dark-gray color. The cavity sanation the lesser omentum. The stitches on the wound of the abdominal wall to drain tube in a small gland.

The next day the patient's condition began to improve significantly. Disappeared bloating. Recovered intestinal peristalsis. In the blood decreased to normal values total number of leukocytes and Palocco-nuclear leukocytes, urea. After a week returned to normal temperature. Drainage stood out Muco-purulent discharge from 50 to 30 ml per day and discontinued on day 33 after surgery. Discharged 10.01.97 was in satisfactory condition with primary wound healing.

The proposed method for the treatment of pancreatic necrosis is x ways of outflow from the pancreas and preservation of the greater mass of tissue of the pancreas.

The method of treatment of pancreatic necrosis by decompression of the pancreas, characterized in that the entire anterior surface of the pancreas produce puncturing the capsules of its segments on the entire thickness of the device, followed by depositing on the perforated surface of the gland sorption drains.

 

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