Method of treatment of necrotic tissue

 

(57) Abstract:

The invention relates to medicine and can be used when carrying out surgical operations on the pancreas. Method of treatment of necrotic tissue is the impact on the fabric of high-voltage pulsed discharge in jet spray mode, the processing of necrotic pancreatic tissue and parapancreatic fiber lead by moving the nozzle Converter with exposure 1-4/cm2at a distance of nozzle 30-50 mm from the pancreas and the consumption kanamycin 0,3-0,35 ml/s, after which the cavity is dried and coagulated tissue pulsed plasma jet with a speed of 2-5 cm/s at an angle of 20-30ofrom a distance of 15-20 mm to the surface of a lesion in the pancreas. The method allows for reorganization and necrotomy of pancreatic necrosis.

The invention relates to medicine and can be used when carrying out surgical operations on the pancreas.

A method of processing high-voltage pulse electric discharge (Vier) abdomen when peritonitis when exposure processing of 0.02; 0,03; 0,05/cm2. The increase of the exposure to which the damaged (abstract Stefanovsky Century,, K. M. N., 2000, S. 20).

There is a method of treatment of peritonitis, is the impact wear in jet spray mode, when the exposure 3-4 c/cm2under certain distance of the nozzle of the transducer from the surface of the exposure and the consumption of antibiotic (RF Patent 2164421, publ. 27.03.01).

The objective of the invention is to increase the effectiveness of treatment due to the removal of degenerated substances.

The problem is solved in that in the method of processing necrotechs tissue by exposing the tissue wear in jet spray mode by moving the nozzle of the transducer at a distance from the affected tissue areas, the impact on necrotic pancreatic tissue and parapancreatic fiber carried out with the exposure time from 1 to 4 s/cm2on the distance of the nozzle from the pancreas of 30-50 mm and at a flow rate of kanamycin 0.3 to 0.35 mg/s, after which the cavity is dried and coagulated tissue pulsed plasma jet when the scanning movement of the plasma torch at a rate of 2 to 5 cm/s at an angle of 20-30oand at a distance of 15-20 mm to the surface of a lesion in the pancreas.

For the treatment of acute pancreatitis, acute focal pancreatic necrosis, what erom stage electrohydraulic hold processing (EGO) affected areas of the gland device Elektron-1, which is the generator of high-voltage electric pulses. It is connected through flexible conductors with EH-Converter, providing the distribution of secondary factors EG-effect (electromagnetic fields, ultrasound and ultraviolet radiation) in the abdominal cavity. The Converter is an opposing rod system with a bit period of the rod-cone. Maximum current bit electric pulse is not less than 500 a, the potential difference at the electrodes - 3-6 kW, pulse duration of about 2 μs, PU pulse - 1,25 ISS, pause - 0,35-0,47 C. the Maximum pulse frequency is 70 Hz. The average number of pulses "one touch" - 4.

The method is as follows.

In the operative wound deduce pancreatic lesion of pancreatic necrosis and process Vier in jet spray mode with exposure time of Aigues-Converter 1-4/cm2the distance of the nozzle from the pancreas of 30-50 mm and the flow rate kanamycin 0.3 to 0.35 g/s Is the process of "evaporation" of necrotic tissue. Then the cavity is dry and move on to a second stage: the formation of a dense coagulation film formation of intravascular clots that reach using lsout installation MCS-4, with the following characteristics:

- adjustment of current pulses of 2.5 - 30 AND

discrete adjustment of the duration of pulses and pauses - 0,02-0,5 s,

the plasma gas flow - 12-30 l/h,

- the consumption of protective gas - 120-240 l/h,

the temperature of the jet of argon - 3000-4000oWITH,

the jet diameter is 1.3 mm,

- length jet - 2.0 mm

- pressure gas - 0.1-0.2 ATM.

After conducting the EGO, the surgeon carries out the process of hemostasis pulsed plasma jets (IPS): pendulum-like scanning movement of the plasma torch with a speed of 2-5 cm/s at an angle of 20-30ofrom a distance of 15-20 mm handles the affected areas of the gland with simultaneous coagulation of bleeding vessels before the formation of a thin light brown crust coagulation scab, preventing charring.

After coagulation of the plasma torch distance and evaluate the effectiveness of treatment and, if necessary, conduct spot coagulation.

The subsequent steps are performed in a known manner (cholecystostomy, combined omentopancreatobursostoma with drainage stuffing bags and retroperitoneal space gauze and tube drainage, suturing wounds and drains).

Programmed the bathroom how agressively to debride promotes rapid removal of degenerated substances from the surface of the body, improves microclimatically drainage of the tissues, which leads to a rapid transition stage of alteration and exudation in the stage of proliferation.

1. Example. The experiments conducted on 35 Guinea pigs. The same animals were in the control group, where the rehabilitation of acute focal necrosis of the pancreas was carried out by a known method.

Overall mortality in the control group was 27 animals (77%). Other: 5 - adhesions, 1 - a cyst in the area of necrosis, 2 - rocky infiltrate.

In animals treated with the proposed method: mortality was 3 animals, 32 - progressive picture juicy granulations in the area of necrosis of the gland with soft elastic scar.

2. Example. Patient S., 28, 05.04.2000 received in the receiving branch of OGKB 1, diagnosed with left renal colic.

Within 12 hours of receipt performed laparoscopy, in which the detected acute edematous pancreatitis. Performed drainage of the abdominal cavity.

06.04.00 surgery: laparotomy. Cholecystostomy. Revision, reorganization of the pancreas and peripancreatic fiber with the use of combination EGO VIR in jet spray mode with exposure time 1/cm2in Ravan. Processing was carried out areas of necrosis in the body and tail of the pancreas IPS when the length of the plasma jet, equal to 2 mm, current 6 a, C mode pulse duration and pause 0.5 seconds, with a speed of 2 cm/s at an angle 30ofrom a distance of 15 mm before formation of a light brown crust. Omentoplasty. Lumbotomy. The drainage of the abdominal cavity and retroperitoneal space.

11.04.00 executed the programmed relaparotomy with revision and combination EGO VIR and IPS pancreas and peripancreatic fiber in still mode.

19.04.00 the patient was transferred from the ICU to the surgical Department.

30.04.00 conducted MRI scan, which detected iron sizes 262022 mm, the contour of her smooth, homogeneous structure.

05.05.00 the patient was discharged with recovery in satisfactory condition.

Method of treatment of necrotic tissue by exposing the tissue of high-voltage pulsed electric discharge in jet spray mode by moving the nozzle of the transducer at a distance from the affected tissue areas, characterized in that the impact on the necrotic tissue of the pancreas and peripancreatic mm, and at the rate of kanamycin 0,3-0,35 ml/s, after which the cavity is dried and coagulated tissue pulsed plasma jet when the scanning movement of the plasma torch at a rate of 2 to 5 cm/s, at an angle of 20-30°C and at a distance of 15-20 mm to the surface of a lesion in the pancreas.

 

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SUBSTANCE: method involves carrying out argon plasma of tracheal and/or bronchial lumen recanalization by applying power of 60-90 W with argond discharge rate being 2.0-2.4 l/min large. Brachitherapy is applied next to it moving the source with 5 mm large step. Trajectory length is 5 to 20 cm large. Reference isodose depth is 10 mm far from the source with applicator moving above and below the tumor from 1 to 3 cm. Dose from 14 to 28 Gr is to be administered once a week in 7 Gr large portions.

EFFECT: enhanced effectiveness of treatment; reduced risk of complications; prolonged remission period.

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