The invention relates to medicine, namely to Oncology and can be applied in the surgical treatment of diseases of the pancreas.

There is a method of treatment of cancer of the pancreas, which consists in performing laparoscopic cholecystostomy at the first stage of surgical treatment, which produce a visual audit of the abdomen and in half of the cases simultaneously with cholecystostomy form of a gastrostomy tube for reinfused bile. (C.R. NV, Artemieva N., Kokhanenko POSTGRADUATE "pancreatic Cancer". Saint-Petersburg "Peter", 2005, s).

However, the above method has a significant drawback. The method does not require decompression of the pancreatic duct at its expansion against the background of concomitant cancer of the pancreas in chronic pancreatitis.

A method of processing the stump of the pancreas failure from imposing pancreaticoduodenal anastomosis, comprising the following: after crossing the pancreas in the neck area and remove the pancreatoduodenal complex shear gland discover the main pancreatic duct and inkubiruut his tube of smaller diameter to a depth of approximately 3 see then perform a thorough hemostasis by lacing bleeding vessels thin filaments. For sealing of the pancreas use the form strand omentum or modify an isolated loop of intestine without opening its lumen (M.V. Danilov, Global VP, Shrubs AU, Myl'nikov, A.G. "a two-stage treatment of the stump of the pancreas when pancreatoduodenal resection". Annals of surgical Hepatology. - 1998. - vol. 3, No. 2, p.51-58).

However, the above method also has significant disadvantages. The method does not involve drainage of the pancreatic duct of the pancreas in the first stage of surgical treatment of cancer of the pancreas, with mechanical jaundice on the background of chronic pancreatitis. The method does not create conditions that allow for the subsequent treatment stages to form a reliable pancreatic anastomosis.

As the prototype was selected method cherishing drainage of uncomplicated cysts of the pancreas under ultrasound control, which consists in performing a diagnostic puncture of the cyst with a needle members 22-20 G under ULTRASOUND control with Radiocontrast study and a laboratory study punctate. In the absence of signs of acute pancreatitis and messages cavity with the main pancreatic duct in the future perform glue occlusion of the cavity of the cyst (M.V. Danilov, Fedorov E, "Re and reconstructive surgery for diseases of the pancreas". Moscow. "Medicine", 2003, s.285).

The method has a significant drawback. It is not about creating conditions for the formation of reliable pancreatic the ski fistula in the second stage of surgical treatment. The method of vysokoaromatichnyj, as Tereshina drainage is not always possible to avoid bleeding from the pancreatic tissue against the background of obstructive jaundice.

The aim of the invention was to increase the reliability of the formation of pancreatic fistula in the second stage of surgical treatment.

This goal is achieved by the fact that intraoperative drain the pancreatic duct to form the Foundation of picturegalleries at the first stage of surgical treatment of cancer of the pancreas on the background of obstructive jaundice, stitch the capsule of the pancreas first seam above the tube for 5 mm perpendicular to the axis of the pancreas, placed second single poluchaetsya seam for 5 mm below the tube parallel to the greater curvature of the stomach, cross and tie 3-4 branches zheludochno-gland arteries and veins in the wall of the stomach, the first ligature stitch the stomach wall perpendicular to the greater curvature over 5 mm in the direction of the lesser curvature, stack tube drainage of the pancreatic duct on the wall stomach parallel to the first seam, place the third seam, be bound the stomach wall to the right and to the left of the drainage tube for 5 mm on each side, tighten the third ligature to the drainage tube, stitch the wall of the stomach along the greater curvature in the ora by ligature of the left and right of the tightened third seam, tighten the first and second ligature, the locking wall of the stomach to the capsule of the pancreas in the field of drainage, drainage output on the skin and locks.

The invention "Method of intraoperative drainage of pancreatic duct with cancer of the pancreas is new, because it is unknown the level of medicine in medical Oncology, surgical treatment of cancer of the pancreas.

The novelty of the invention lies in the fact that at the first stage of surgical treatment drained pancreatic duct, and the conditions that allow subsequently form a reliable pancreatic fistula by suturing the stomach wall and fixing the walls of the stomach to the body of the pancreas.

The invention is industrially applicable, as may be repeatedly reproduced and applied in health care, in hospitals specialized profile in General and specialized cancer hospitals.

The method is as follows:

Perform laparotomy. Intraoperatively placing an ultrasound probe on the tissue of the pancreas in the packing bag and the dotted line pancreatic duct. Drain the pancreatic duct to form the Foundation of picturegalleries at the first stage of surgical treatment of cancer under lodochnoy cancer on the background of obstructive jaundice (Figure 1). Stitch the capsule of the pancreas first seam above the tube for 5 mm perpendicular to the axis of the pancreas (1). Placed second single poluchaetsya seam for 5 mm below the tube parallel to the greater curvature of the stomach (2). Cross and tie 3-4 branches zheludochno-gland arteries and veins in the wall of the stomach (Figure 2). The first ligature stitch the stomach wall perpendicular to the greater curvature over 5 mm in the direction of the lesser curvature (3). Stack tube drainage of the pancreatic duct to the stomach wall parallel to the first seam (Figure 3). Impose a third seam, be bound the stomach wall to the right and to the left of the drainage tube for 5 mm on each side (4). Tighten the third ligature on the drainage tube (Figure 4). Stitch the wall of the stomach along the greater curvature of the second ligature of the left and right of the tightened third seam (5). Tighten the first and second ligature, the locking wall of the stomach to the capsule of the pancreas in the area of drainage. Drain output on the skin. Fixed. At the second stage after pancreatoduodenal resection form picturegalleries, using the wall of the stomach around the tube as its Foundation.

Example:

Patient P s, 56, № East. disease 1618/t entered the Rostov cancer research Institute 20.05.04, the clinic is mehanicheskij jaundice. Previously the patient at the place of residence was performed ultrasound examination where diagnosed with a tumor in the pancreatic head. The patient is taken to the operating room. At laparotomy revealed a tumor in the pancreatic head, intense gallbladder, advanced choledoch and pancreatic duct. Completed suspension cholecystectomy. Under ultrasound control was punctilobula pancreatic duct. Flashed the capsule of the pancreas first seam above the tube for 5 mm perpendicular to the axis of the pancreas. Put the second single poluchaetsya seam for 5 mm below the tube parallel to the greater curvature of the stomach. Crossed and tied 3-4 branches of the gastroepiploic arteries and veins in the wall of the stomach. The first ligature flashed the stomach wall perpendicular to the greater curvature over 5 mm in the direction of curvature. Put the tube draining the pancreatic duct to the stomach wall parallel to the first seam. Put the third seam, be bound the stomach wall to the right and to the left of the drainage tube for 5 mm on each side. Delayed third ligature on the drainage tube. Flashed the wall of the stomach along the greater curvature of the second ligature of the left and right of the tightened third seam. Delayed first and second ligature, the locking wall of the stomach to the capsule of the pancreas is the area of drainage, drainage is brought to the skin, recorded. The patient was discharged from the hospital on the 18th day.

Technical and economic efficiency of the method is that when cancer of the pancreas associated with chronic pancreatitis and expansion of the pancreatic duct can create conditions for the formation of reliable pancreatic fistula in the second stage of surgical treatment that allows prevent pancreatitis stump of the pancreas, improves the quality of life of patients, reduces hospital bed day.

The way intraoperative drainage of pancreatic duct with cancer of the pancreas, characterized in that the first stage of surgical treatment of cancer of the pancreas on the background of obstructive jaundice place the ultrasonic sensor in the pancreatic tissue in the packing bag and the dotted line pancreatic duct under ultrasound guidance, intraoperative drain the pancreatic duct, stitch the capsule of the pancreas first seam above the tube for 5 mm perpendicular to the axis of the pancreas, placed second single poluchaetsya seam for 5 mm below the tube parallel to the greater curvature of the stomach, cross and tie 3-4 branches of the gastroepiploic arteries and veins in the wall of the stomach, the first ligature stitch wall Gelu the spacecraft perpendicular to the greater curvature over 5 mm in the direction of the lesser curvature, stack tube drainage of the pancreatic duct, the wall of the stomach parallel to the first seam, place the third seam, be bound the stomach wall to the right and to the left of the drainage tube for 5 mm on each side, tighten the third ligature to the drainage tube, stitch the wall of the stomach along the greater curvature of the second ligature of the left and right of the tightened third joint, tighten the first and second ligature, the locking wall of the stomach to the capsule of the pancreas in the field of drainage, drainage output on the skin and is fixed, at the second stage after pancreatoduodenal resection form picturegalleries, using the wall of the stomach around the tube.