A method of surgical treatment of pancreatic necrosis
The invention relates to medicine, namely to surgery, and may be applicable for the surgical treatment of pancreatic necrosis. Enter seamless cross drainage tube through the middle laparotomic wound, gastrocolic ligament in the packing bag, and then through the generated channel in the retroperitoneal space from the tail of the pancreas under the splenic angle of the colon. Remove the drain tube through an incision in the left lumbar region. Drainage pipes are provided in the middle part of the perforation. The method allows to reduce the trauma, to provide adequate drainage stuffing bags for a long time, to reduce the treatment time.
The invention relates to medicine, in particular, to surgical gastroenterology.
The urgency stems from the unsatisfactory results of treatment of pancreatic necrosis.
When pancreatic necrosis inflammatory process often extends beyond the pancreas and causes various inflammatory changes in the surrounding pancreatic tissue. Necrotic process due to the alteration of tissue activated proteoliticeski the th peripancreatic tissue and accumulates in the omental pouch. All this leads to the development of metobolite, parapancreatic phlegmon and often retroperitoneal phlegmon, and further in case of inadequate treatment is infection and abscesses are formed in the pancreas and various areas of the retroperitoneal space. Up to the present time there is no unity in the approach to surgical treatment of pancreatic necrosis, so there are many different surgical techniques for the treatment of pancreatic necrosis, which can be divided into three groups: closed, semi-open and open.
Analog is a method of surgical treatment of pancreatic necrosis, called marsupialization, in which the opening of the stuffing bags by midline laparotomy and dissection of the gastrocolic ligament, remove necrotic lesions of the pancreas by finger crushing, after which the edges cut the gastrocolic ligament is stitched to the parietal peritoneum edges laparotomic wound and drain the cavity stuffing bags with subsequent lavage. (Ivanov, Y. C., Mozgalin A., Annals of surgery. - M., 1999, №3, p. 10).
A significant drawback of surgery is bad outflow of the contents of the stuffing bags into the drainage tube, such blind ends in the wound quickly clogged with fibrin and necrotic masses, making it more difficult to drain from the wound. All this leads to inadequate drainage of pancreatic necrosis as a consequence of further expansion and deepening of the inflammatory process.
The prototype can serve as surgery for the treatment of pancreatic necrosis, which abdominal pancreas, developed by C. A. Kozlov in 1977 Operation is carried out as follows: after a median laparotomy and dissection of the gastrocolic ligament dissect the parietal peritoneum along the top and bottom edges of the pancreas. The body and tail of the gland bluntly separated from the retroperitoneum and iron envelop flap of omentum. Between the gland and the gland is placed drainage tube with side holes, which is brought out through a separate incision in the left lumbar region (Saveliev C. S., Buyanov C. M., Ognev Y. C. Acute pancreatitis. - M.: Medicine, 1983, S. 209-211).
The disadvantage of surgery is high risk of injury to major vessels and lymphatic duct behind the pancreas and indistinct in the deathly altered tissue. In addition, additional infection and lysis is subjected to the greater omentum, summed up under necroticism for a few cavities, what hinders the outflow of stuffing bags. Drainage installed to the pancreas hollow and extending through an incision in the left lumbar area due to static position the end, quickly distinguished purulent-necrotic masses and does not provide adequate drainage.
The objectives of surgical treatment of pancreatic necrosis are the maximum delimitation of the area of operations from the free abdominal cavity, adequate drainage stuffing bags for a long time until full discharge sequestered tissue, minimal invasiveness of the surgery.
When pancreatic necrosis is the destruction of the pancreas covering the parietal peritoneum, and the process is separated from the abdominal area stuffing bags and distributed in fiber parapancreatic space, located in the lower abdomen.
The technical novelty of the proposal is that seamless cross drainage tube is inserted through the middle laparotomic wound gastrocolic ligament in the packing bag, and then through the generated channel in the retroperitoneal space from the tail of the pancreas under the splenic angle of the colon Kish is the situation. Free abdominal cavity separated from the field of natural drainage anatomical structures and it is not infection.
The method is as follows: perform verhnesadovoe laparotomy small size, then by dissection of the gastrocolic ligament reveal packing bag. Remove all loose sequesters, packing bag disclose all parapancreatic the pathological accumulation of fluid, then stupidly left open retroperitoneal space at the bottom edge of the tail of the pancreas and make a channel under the splenic angle of the colon, and then in the left lumbar region with an incision of the abdominal wall and the channel towards the previous, in the presence of cellulitis of the left retroperitoneal space is an autopsy done through the channel. Then in the packing bag set seamless (end-to-end) controlled drainage tube (4-5) with side holes in the middle part and the ends of the tubes output: front - through the gastrocolic ligament and the median wound, and gastrocolic ligament is sutured to the drains, and from the side through an incision in the left lumbar region. Immediately after the end of the nation. The drains can be easily controlled by regular movement around and along its axis, and the side holes thus serve as a “brush”. Flow-suction drainage while providing a constant evacuation of necrotic tissue and pathological fluid from the stuffing bags and retroperitoneal space.
The method is tested on 21 sick.
Patient Nemchenko, S., 38, East. disease No. 5798, received 25.03.03, with severe pain in the abdomen, accompanied by repeated vomiting and bloating. The patient immediately hospitalized in the intensive care unit for intensive therapy with a diagnosis of acute pancreatitis. The diagnosis is confirmed by ultrasound and computed tomography: there are signs of pancreatic necrosis. The severity of the condition on a scale Apach - 2 - 7 points. 27.03.03, an ultrasound revealed fluid in the pelvis, where installed drainage under sonographic control. Conducted conservative treatment effect was not given to 6 days marked increase of endotoxemia, and MRI - denominated necrotic changes in the pancreas and peripancreatic tissue and omental pouch. Was made upper median laparotomy small size, then cut the gastrocolic ligament and opened stuffing the bag from the cavity stuffing the bag was evacuated about 300 ml brown murky liquid, after which he was diagnosed with a pancreatic necrosis throughout the pancreas with the formation of necrosis in the retroperitoneal tissue of the left retroperitoneal space, the loose sequestrum is not revealed. Then at the bottom edge of the tail of the pancreas was dissected retroperitoneal space and stupidly done the channel in a deathly modified retroperitoneal tissue under the splenic angle of the colon, and then in the left lumbar region was performed abdominal incision and reported on its channel. Then in a packing bag were conducted 4 seamless cross drainage tube with the holes in the middle part. The tube is inserted through the middle laparotomic wound and cut gastrocolic ligament in the packing bag, and is output through the channel in the retroperitoneal space and the incision in the lumbar region. Then through the drainage tube was conducted continuous flow-suction drainage. After surgery positive to dinamicas sequestered tissue. When the control computer tomography from 07.04.03,, 21.04.03, and 06.05.03, marked a significant improvement. The patient was discharged to 45 days after surgery in satisfactory condition.
The technical result of the invention is to reduce the morbidity of surgical treatment as due to the operation itself, and by eliminating the risk of execution relaparotomy, no postoperative complications, reducing the time of occurrence of a positive effect in the course of the disease. Ultimately achieved significant financial savings in treatment costs.
A method of surgical treatment of pancreatic necrosis, including median laparotomy and drainage of stuffing bags, characterized in that seamless cross drainage tube is inserted through the middle laparotomic wound, gastrocolic ligament in the packing bag, and then through the generated channel in the retroperitoneal space from the tail of the pancreas under the splenic angle of the colon and out through an incision in the left lumbar region, and a drain tube in the middle part provided with a perforation.
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