Surgical method of preventing the progression of pancreatic necrosis

 

The invention relates to medicine, surgery may be used in the treatment of pancreatic necrosis. Kateteriziruyut main pancreatic duct. Set of holes of the catheter at the level of head and body. One end is brought out through the major duodenal papilla into the duodenum, stomach and through microgastrinae on the anterior abdominal wall. The second end of the catheter display on the anterior abdominal wall. Through drainage spend rehabilitation lavage fluids, antiseptic, antibacterial therapy. In particular, if you spend lavage with 20 ml of 1% aqueous solution dioksidina dissolved in 100 ml of isotonic NaCl in a specific mode. The method allows to increase the efficiency of the decompression in the pancreatic necrosis. 1 C.p. f-crystals, 1 Il.

The invention relates to medicine and can be used in surgical practice.

To prevent the progression of necrosis and suppuration of dead tissue in the currently used methods of endoscopic papillosphincterotomy, canulli Wirsung duct occured and aspiration secret, introducting the introduction of inhibitors of secretion of the pancreas.

A known method of preventing the progression of acute pancreonecrosis (pathogenetic substantiation of diagnosis, tactics of treatment and prevention). Abstract....Diss. Prof. the honey. of Sciences, 1996).

Known injection of dalargin in the ductal system of the pancreas in patients with acute pancreatitis when duodenoscopy with Teflon catheter, which kanyoro main pancreatic duct retrograde. The introduction of dalargin is carried out after preliminary aspiration of pancreatic secretions within 5 minutes (M. P. Erokhin, I. N. Markov, S. M. Night, Y. W. Of Rostov. Application intraductal injection of dalargin in acute pancreatitis. //IX all-Russian Congress of surgeons. Volgograd, September 20-22, 2000, S. 41-42).

The disadvantages of the known methods are: - intraductal introduction of medicinal substances subject to hyperplasia and a large amount of dangerous damage doctorines compounds and progression of necrosis, as well as application methods requires highly skilled endoscopists that owns the method of koulali Wirsung duct occured.

Known application of momentary or prolonged decompression by deep catheterization of the main pancreatic duct and the suction secret. When simultaneous decompression are actively aspiration secret for 30-40 minutes. Prolonged nasop the population of pancreatic juice, its viscosity and color (Y. A. Nesterenko, A. N. Lishchenko, S. C. Mihalyov. Purulent-necrotic complications of acute pancreatitis (guidance for doctors and teachers, 1998, page 80).

The disadvantages of the method are: - migration of the drainage of the duct, as well as complications of the lungs, especially in the elderly (pneumonia).

The objective of the invention is to increase the efficiency of the decompression and rehabilitation ductal system of the pancreas with pancreatic necrosis.

The problem is solved in that in the surgical method of preventing the progression of pancreatic necrosis, including catheterization of the main pancreatic duct, the duct lumen catheter with side holes, which are mounted on the head and body of the pancreas, one end of the catheter is brought out through the major duodenal papilla into the lumen of the duodenum 12 and then into the stomach, and through microgastrinae on the anterior abdominal wall, the second end also bring to the abdominal wall, fixed with a ligature and formed through the drainage spend rehabilitation lavage fluids, antiseptic and antibacterial therapy with regard to sowing microflora. The problem is solved also by the fact that the lavage spend 20 ml of 1% solution is tervalon 8 hours.

The figure schematically shows the drainage of the pancreas, where: 1 - pancreas, 2 - 12 duodenal intestine, 3 - stomach, 4 - large duodenal papilla, 5 - main pancreatic duct, 6 - transpancreatic drainage, 7 - anterior abdominal wall.

The method is as follows. In a patient with common hemorrhagic necrotic pancreatitis intraoperative perform abdominal pancreas by the method of C. A. Kozlov. On the border of the body and tail of the gland using the dissector, alternating longitudinal and transverse motion, separate the cloves on midorikawa periods of exposure to the walls of the Wirsung duct occured. With a scalpel to expose the lumen of the duct 5, which is injected ureteric catheter 6 corresponding in diameter with multiple side holes. The catheter (transpancreatic drainage) 6 output through the major duodenal papilla 4 into the lumen of the duodenum 12 2 and into the stomach 3, and formed through microgastrinae on the anterior abdominal wall 7. The perforations of the drainage installed at the level of the head and body of the gland. Both ends of the drainage output to the left of the wounds of the abdominal wall and fixed on the skin by the ligature. After the establishment of drainage opredelit and amylase activity.

In the postoperative period through transpancreatic drainage 6 intraductal provide continuous lavage ductal system, 20 ml of 1% solution dioksidina dissolved in 100 ml isotonic sodium chloride at 60 drops per minute 3 times a day with an interval of 8 hours. Spend sowing secretion of the pancreas on the microflora. Enter inhibitors of secretion of the pancreas: sandostatin dose of 50 mg 2 times a day 5 ml isotonic sodium chloride for 5 days or dalargin in a dose of 60 μg/kg of patient's weight in 5 ml of isotonic sodium chloride and 0.25% solution of novocaine 100 ml at 60 drops per minute 3 times a day with an interval of 8 hours. Introduction medicinal drugs perform retrograde (from head to tail) that fills in all the departments of the ductal system of the gland.

During the day three times, every 8 hours, determine the flow of pancreatic juice with a study of the activity of amylase in it. During the first 10 days after surgery every 3 days, and then daily during the week send a secret for microbiological examination. In case of positive results of crops is carried out intraductal of Antibacterials the th and negative crops secret on the microflora.

Example. Patient N., 52 years old, was admitted to the hospital after 48 hours from the onset of the disease with clinical signs of peritonitis. Clinical diagnosis: Common hemorrhagic pancreatic necrosis. Aseptic peripancreatic abscess. Common enzymatic peritonitis, toxic phase. Performed the autopsy stuffing bags, abdominal pancreas according to the method of C. A. Kozlov, installed transpancreatic drainage on the proposed method, toilet, drainage of the abdominal cavity. Drainage were estimated to be approximately 5 ml of turbid with flakes of fibrin secret (bacterial culture test). After surgery established system with 20 ml of 1% solution dioksidina dissolved in 100 ml isotonic Nl at 60 drops per minute 3 times a day with an interval of 8 hours. In between the introduction dioksidina enter sandostatin dose of 50 mg 2 times a day 5 ml isotonic sodium chloride solution for 5 days and 0.25% solution of novocaine 100 ml at 60 drops per minute 3 times a day every 8 hours for 10 days. Introduction medicinal drugs perform retrograde. Through 3 days after the operation is repeated seeding of pancreatic juice for bacteriological examination and determination justice therapy apply extracorporeal detoxification methods, programmed rehabilitation stuffing bags. Daily determine the flow of pancreatic juice, which for 7 days did not exceed 5 ml After 7 days was ready intraoperative seeding of pancreatic secretions on the micro - result negative. Continue regional introduction dioksidina and novocaine as described above. After 10 days, has changed the nature of the secret to more transparent. With 10 days of pancreatic juice sent for bacterial culture test daily - result negative. Intraductal introduction dioksidina and novocaine continue to normalization of clinical and laboratory parameters.

On the 25th day after the operation, the drain is removed, functioning incomplete pancreatic fistula was closed after 5 days. The patient was discharged on the 32nd day in a satisfactory condition. Surveyed after 6 months, no complaints. Ultrasound of the pancreas cystic formations not found.

Using the developed method operated on 10 patients. Suppurative complications were not. The method is applicable in disseminated hemorrhagic pancreatic necrosis, abscess, not beyond the peripancreatic fiber space.

P is dinamicheskoi assessment of the pathologic process, including the period of rehabilitation, and exercise rehabilitation lavage ductal system antiseptic solution and enter the drug directly to the tumor necrosis.

Claims

1. Surgical method of preventing the progression of pancreatic necrosis, including catheterization of the main pancreatic duct, characterized in that the duct lumen catheter with side holes, which are mounted on the head and body of the pancreas, one end of the catheter is brought out through the major duodenal papilla into the lumen of the duodenum 12 and then into the stomach, and through microgastrinae on the anterior abdominal wall, the second end also bring to the abdominal wall, fixed with a ligature and formed through the drainage spend rehabilitation lavage fluids, antiseptic, antibacterial therapy with regard to sowing flora.

2. The method according to p. 1, characterized in that the postoperative lavage spend 20 ml of 1% solution dioksidina dissolved in 100 ml of isotonic NaCl at 60 drops per minute 3 times a day every 8 hours

 

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FIELD: medicine.

SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.

EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.

5 cl, 1 dwg

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