RU2180530C2 - Method for treating pancreatic false cysts - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves determining pancreatic duct fistula zone. Main duct of the pancreas is opened through the fistula zone. Pancreaticoenteric draining is carried out by connecting the intestine with the created pancreatic fistula through the cyst cavity. EFFECT: enhanced effectiveness of pancreaticoenteric anastomosis drainage. 2 dwg

Description

 The claimed invention relates to medicine, namely to surgery, and can be used to treat patients with pancreatitis.

 Closest to the proposed method are the implementation of an internal anastomosis between the small intestine and the wall of the false pancreatic cyst and resection of the cyst with the simultaneous execution of the internal anastomosis between the small intestine and the pancreas [1, 2].

 However, the method of performing an internal anastomosis between the intestine and the cyst, despite the technical simplicity, does not provide high-quality and reliable drainage of the duct system of the pancreas due to the presence of an interanastomotic cavity.

 The method of removing the cyst and the subsequent application of an anastomosis between the intestine and the opened lumen of the pancreatic duct is characterized by unjustified radicalism and trauma.

 The purpose of the invention is to increase the effect of drainage of pancreatic intestinal anastomosis with the elimination of the cavity of the false pancreatic cyst with lesser surgical injury.

 The essence of the invention consists in the formation of an anastomosis between a segment of the jejunum and pancreatic duct, performed through the opened cavity of the pancreatic cyst. The intestinal wall is connected to the pancreatic tissue after transcancreatic opening of the pancreatic duct with a single-row twisted seam with synthetic absorbable atraumatic suture type Polysorb 4/0. The course of the needle is oriented through the wall of the false cyst, pancreatic tissue and pancreatic duct, and then intestinal tissue to the submucosal layer.

 The method is carried out in the following way.

 In patients with false pancreatic cysts, regardless of their size, an abdominal cavity is opened under general anesthesia. Next, the gastrocolic ligament is opened with access to the cyst. A diagnostic puncture of the cyst is performed, followed by a wide opening of its cavity and exposure of the ventral surface of the pancreas. The zone of the formed fistula of the pancreatic duct is visually determined and through it the lumen of the main duct of the gland opens with a length of at least three centimeters. Sounding of the ducts and determination of the occlusion zone are performed. Through the window into the mesocolon and the wall of the cyst, the jejunum isolated by the interintestinal anastomosis is brought to the gland, its lumen is opened adequately to the length of the pancreatic wound, and the gut is connected to the formed pancreatic fistula. A circular anastomosis is superimposed by a continuous single-row suture with an atraumatic absorbable suture of the Polysorb 4/0 type. The cyst cavity is drained by safety drainage for three days. The gastrocolic ligament is restored. The abdominal cavity is sutured tightly (Fig. 1, 2).

 When comparing the results with data obtained by other methods, a high reliability of the treatment method for patients with a low risk of complications in the early postoperative period was revealed. At the same time, a reduction in the duration of treatment and a decrease in the cost of using therapeutic agents due to the simultaneous treatment of a false cyst and intrapancreatic hypertension in the pancreas were achieved.

 Example 1. Patient K., East. 214287, 55 years old, operated on 07.10.98 in the surgical department of the City Clinical Hospital 11, Ryazan. Clinical diagnosis: chronic pseudotumor pancreatitis. Giant false pancreatic cyst. An operation was performed to superimpose a longitudinal pancreatoenteroanastomosis according to Cattel in the modification of Shalimov. The length of the longitudinal pancreatodototomy is 70 mm, without excision of the edges. Cyst volume 4 l. The postoperative period was uneventful. Operated repeatedly after 3 months in connection with the development of obstructive jaundice due to compression of the common bile duct by pancreatic tissue from the outside. Performed supraduodenal choledochoduodenostomy and revision of pancreatoenteroanastomosis. An infection of the pancreatoenteric anastomosis was detected. Anastomosis was restored through the enterotomy opening. Discharged in satisfactory condition.

 Example 2. Patient K., East. 218474, 32 years old, operated on 12/11/98 in the surgical department of the City Clinical Hospital 11, Ryazan. Clinical diagnosis: chronic calculous pancreatitis. Giant false pancreatic cyst. Compression of the portal vein. Subhepatic portal hypertension. An operation of transcystic pancreatoenterostomy according to Ru was performed with a stump of a sequestered body-tail segment, with a pancreatic duct expanded to 4 mm open in the center. The volume of the cyst is 3 liters. The postoperative period was uneventful. Discharged on the 12th day in satisfactory condition.

 Example 3. Patient K., East. 2090101, 58 years old, operated on 09.06.98 in the surgical department of the Clinical Hospital 11, Ryazan. Clinical diagnosis: chronic pseudotumor pancreatitis. Giant false pancreatic cyst. An operation was performed to superimpose a longitudinal pancreatoenteroanastomosis according to Cattel in the modification of Shalimov. The length of the longitudinal pancreatroduktotomy 60 mm, without excision of the edges. The volume of the cyst is 3 liters. The postoperative period was uneventful. Discharged for outpatient treatment in satisfactory condition.

 Example 4. Patient K., East. 302251, 41 years old, operated on 02.16.99 in the surgical department of the City Clinical Hospital 11, Ryazan. Clinical diagnosis: chronic pseudotumor pancreatitis. Giant false pancreatic cyst. An operation was performed to superimpose a longitudinal pancreatoenteroanastomosis according to Cattel in the modification of Shalimov. The length of the longitudinal pancreatroductotomy is 40 mm, without excision of the edges. The volume of the cyst is 2 liters. The postoperative period was uneventful. Discharged in satisfactory condition.

Sources of information
1. Cysts and fistulas of the pancreas / Vilyavin GD, Kochiashvili V.I., Kaltaev K.K. - M .: Medicine, 1977 .-- 192 p., Ill.

 2. A method for the treatment of pancreatic cysts // Copyright certificate 973708 of 04.17.80. - A.A. Shalimov et al.

Claims (1)

 A method for treating false pancreatic cysts by means of internal pancreatic-intestinal drainage, characterized in that the zone of the fistula of the pancreatic duct is previously determined, the lumen of the main duct of the pancreas is opened through it, and pancreatic-intestinal drainage is performed by connecting the intestine with the formed pancreatic fistula through the cavity of the cyst.

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