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/lAn. 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 unit09.12.96, 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.
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