RU2188045C2 - Method for treating cases of pancreonecrosis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying Shivyrtuin granules impregnated with 5% epsilon-aminocaproic acid solution in 3:1 proportion as sorbent agent. Lymphostimulation and gastroenteric and biliferous tract draining are additionally carried out. Pubic vein recanalization is performed and hemodiluting agent is introduced. Intraportal anti-enzymatic infusion therapy is applied. EFFECT: enhanced effectiveness of treatment. 2 cl

Description

 The invention relates to medicine, in particular to abdominal surgery, is intended for the treatment of acute destructive pancreatitis and its purulent complications.

 According to B.C. Savelyeva and V.A. Kubyshkina [1], "pancreatic necrosis is one of the most impressive catastrophes of the abdominal cavity, so far it remains a disease with an unpredictable outcome." The authors rely on an analysis of the case histories of 191 patients with pancreatic necrosis and 163 with edematous pancreatitis; they consider it appropriate to distinguish only these two forms of acute pancreatitis, without dividing them into fatty, hemorrhagic and other forms of pancreatic necrosis. The surgical manual considers it necessary to conduct a broad mobilization of the pancreas from retroperitoneal tissue, if necessary, perform distal resection, if this is not possible, perform necrectomy with drainage of the omental bursa and retroperitoneal space with mandatory biliary decompression.

 The tactics of surgical treatment of pancreatic necrosis are diverse. Some authors limit themselves to opening phlegmon, draining the omental bursa and abdominal cavity, then relying only on drug therapy, others - proponents of active influence on the necrotic sites perform staged necrcestrectomy during programmed relaparotomy, and others - use sorbents for active absorption of necrotic masses in the pancreas itself and around her. However, unresolved issues remain in the choice of the sorbent, the use of dosage forms based on it, as well as the use of drugs that enhance and accelerate the rejection of necrotic masses.

 A known method of treating acute pancreatitis (AS 1313431 A1, Sh.I. Karimov, P.V. Kuzionov, publ. 30.05.87, BI 20) [2], based on the fact that they perform laparotomy, mobilize the pancreas, translating it from the extraperitoneal position to the intraperitoneal (abdominal). According to the indications, an economical or subtotal resection or sequestrectomy is performed, the gland is covered with a U-shaped drainage, the ends of which are brought out - one through the gastrointestinal ligament, the other through the small omentum and through this drainage the gland is hypothermic with cooled solutions of medicinal substances.

 However, the progression of necrosis is not ruled out and the newly appeared foci of destruction are not sanitized. Tubular drainage covers only a fragment of the gland, which does not allow for total hypothermia. In addition, there is no element of dynamic visual assessment of the state of the organ and surrounding tissues.

 There is a method of treating pancreatic necrosis (A.S. 1344326 A1, A.A. Shalimov, S.E. Kozyryatov, publ. 15.10.87, BI 38) [3], the essence of which is as follows: laparotomy is performed, necrotic areas are removed pancreas, catheterization of the main pancreatic duct and retrograde injection of KL-3 glue into it under pressure until the latter appears uniformly over the entire surface of the gland in order to eliminate further enzymatic autolysis.

 However, necrotic tissue remains both in the gland itself and in the surrounding fiber, which supports endotoxemia and does not exclude other purulent-necrotic complications. In addition, there is no visual dynamic monitoring of the state of the pancreas.

 A known method of mobilization of the pancreas with pancreatic necrosis (a.p. 1581284 A1, V.N. Shilenok, N.G. Kharkevich, S.I. Leonovich, E.Ya. Zeldin, V.N. Sobol, publ. 30.07.90 , BI 28) [4], according to which the omentum bag is opened, exudate is removed, the parietal peritoneum is dissected, the splenic corner of the colon, descending colon are mobilized, then the tail and body of the pancreas are isolated. Cross the posterior sheet of the peritoneum along the upper and lower edges of the pancreas (abdominization), drain the retroperitoneal tissue behind the mobilized pancreas and descending colon, as well as the omental sac through the lumbotom opening on the left below the 12th rib. In a destructive process in the head of the pancreas, the latter is mobilized together with the duodenum and is similarly drained on the right.

 However, passive drainage, as practice has shown, is not enough for a progressive destructive process in the pancreas, accompanied by an abundant release of enzymes in the blood and lymph channels. A significant part of the toxins remains in the abdominal cavity and is not removed through the drainage system. In addition, there is no element of visual dynamic control over the state of the pancreas and surrounding tissues.

 A known method of treating acute destructive pancreatitis (a.s. 140923 A1, B. S. Gakov, O. E. Nifantiev, Yu.A. Maliglovka, V. A. Fokin, E. A. Selezov, publ. 15.07.88, BI 26) [5], the essence of which is as follows. An upper middle laparotomy is performed, a bag of synthetic semi-impermeable membrane is placed directly to the pancreas, and local peritoneal dialysis is performed only in the gland area.

 However, dialysis allows you to remove only the low molecular weight fraction of toxins, enzymes and other products that can penetrate through such a membrane, while large molecular structures, fragments of necrotic tissue of the gland remain in the abdominal cavity and cause severe endotoxemia.

 A known method of treating destructive pancreatitis (AS 1243705 A1, N. G. Mamedov, V. I. Chernov, V. I. Shepotinovsky, publ. 07.15.86, BI 26) [6], based on laparotomy, opening the omental bags, necrosecestrectomy, resection of the external fragment of the gland with the main pancreatic duct in the form of a cone in the area of the tail and body, followed by tamponade of the defect with a lock of the greater omentum and suturing of the latter with U-shaped sutures in order to preserve the endocrine function of the gland and spleen as an organ.

 However, the method along with its morbidity and bloodiness does not provide for the continuous effective removal of necrotic masses, enzymes, and other products causing endotoxemia.

 The closest analogue, taken as a prototype, the method of surgical treatment of pancreatic necrosis, described in the monograph of N. A. Lopatkina and Yu.M. Lopukhina - "Efferent methods in medicine" [7] (p. 136). The method is as follows. A laparotomy is performed, abdominal sanitation is performed, the gastrointestinal ligament is dissected, the omental bursa is sanitized. In the presence of the corresponding indications - sequestration is performed - or necrectomy. Then in a stuffing bag over the pancreas, and, if necessary, around the gland after its abdomination, gauze bags with fibrous sorbent (AUVM) enclosed in them or semipermeable capsules with granular hemosorbent are placed. The same packages or capsules with a sorbent are placed in the places of the greatest accumulation of exudate in the abdominal cavity - in the subphrenic and subhepatic spaces, lateral canals, interloop spaces, small pelvis. Sorbents absorb exudate and toxic substances from the abdominal cavity and stuffing bag, contributing to the rapid elimination of peritonitis. To control the state of the pancreas and abdominal cavity, as well as to replace spent sorbents, a metal fastener is sewn into the front abdominal wall. Sanitation of the abdominal cavity and stuffing bag and sorbent replacement is performed daily until the signs of peritonitis are eliminated, the rejection of the necrotic pancreas is stopped, and the demarcation line appears. Then the metal fastener is removed and the abdominal cavity is sutured tightly. The terms of treatment are individual and depend on the speed of stopping the phenomena of peritonitis and stopping rejection of the necrotic pancreas [7, p. 137].

 However, the fibrous sorbent AUVM or granular hemosorbent used according to the prototype does not have anti-inflammatory, deodorizing, ion-exchange properties, they are used in their pure form and do not carry medicinal compositions, which, of course, affects the activity of sorption therapy and, as a consequence, the effectiveness of treatment. In addition, the use of only sorption therapy to stop the effects of endotoxemia is clearly not enough.

 In the inventive method, to increase the effectiveness of the treatment and eradicate endotoxemia by enhancing the activity of sorption therapy, shivirtuin granules pre-saturated with a solution of 5% epsilonaminocaproic acid in a ratio of 3: 1 and introduced in suspension in a mesh container made of synthetic tissue are used as an sorbent, and lymphostimulation is additionally carried out , enhancing the lymphatic production of the liver, for which hemodilutant, for example reopoliglukin, is introduced through a recanalized umbilical vein.

 The method is as follows. Under general anesthesia, the median supra umbilical laparotomy is performed, the organs are revised and the abdominal cavity is sanitized, the omental bursa is opened through the gastrointestinal ligament, the omenobursopancreatostomy is formed, the parietal peritoneum is opened on the upper and lower pancreas, necrectomyectomy is necessary for necrorectomy parapancreatic fiber, resection of the tail of the gland with necrosis in this department is possible. Nasointestinal intubation is performed with an enteral probe, which is attached to the wing of the nose. In the round ligament of the liver, the umbilical vein is found, isolated and opened, its recanalization and catheterization are performed. The catheter is brought to the abdominal wall through a separate puncture to the right of the laparotomy wound, attached to the skin. An extrahepatic biliary tract is revised to exclude the presence of stones, a cholecystostomy is formed for external drainage of the biliary tract. In the absence of the gallbladder, a choledochostomy is performed. The stuffing bag is drained by tubular drains - on the right through the Vinslov hole, on the left through the gastrocolic ligament or retroperitoneal space in the left hypochondrium. Containers made of nylon mesh with shivirtuin granules saturated with EAAA in a ratio of 3: 1 are placed in an omentum bag along the entire length. The containers are shaped like cakes or sausages so that their surface is most closely in contact with the foci of destruction in the gland and surrounding tissues. A separate container is placed in the laparotomy wound. On top of the wound - a bandage with ointments on a water-soluble basis (levosin, levomekol). Every day under anesthesia, the containers with the sorbent are replaced with new ones. After complete reorganization of the stuffing bag, it is drained through the abdominal wall and the gastrocolic ligament, or the old drains are replaced, and early secondary sutures are applied to the laparotomy wound.

 Clinical experience suggests that improving portal blood circulation through a catheterized umbilical vein has a beneficial effect on liver function and lymph production by this organ. The impact on biologically active substances in the portal system significantly reduces endotoxemia, since enzymes, medium-weight molecules and other substances are neutralized in this system, without getting into or getting into a much smaller amount in the systemic circulation. Intraportal antienzyme infusion therapy prevents the possible overload of the pulmonary circulation, which is often observed with infusions through the subclavian, cubital veins, especially since with pancreatic necrosis pulmonary complications are frequent and dangerous. Using the intraportal route, we prevent the development of distant purulent-necrotic metastatic complications.

 Decompression of the biliary tract through cholecyst or choledochostoma is an additional and mandatory benefit that improves the outflow along the main pancreatic duct and normalizes liver function.

 The use of the shivirtuin mineral as a sorbent makes it possible to enhance the adsorption effect due to the presence of two sorbents (zeolite and white clay), which together have a large sorption capacity. Shivirtuin mineral itself, as shown by clinical data and experimental materials, has pronounced anti-inflammatory, biostimulating effects, it has deodorizing and fibrinonecrolytic effects, it is an active ion exchanger. The nylon mesh into which the sorbent is placed has greater mechanical strength than gauze, the optimal gauge of the mesh cells prevents the shivirtuin granules from falling into the abdominal cavity. The mineral is completely saturated with necrotic tissues in 24 hours, which is proved by studying the level of protein and enzymes in a sorbent unit.

 Epsilon-aminocaproic acid (Acidum aminocapronicum, Aminocaproic acid) adsorbed on shivirtuin has a wide range of therapeutic effects. By blocking plasminogen activators and partially inhibiting the action of plasmin, EACA has a specific hemostatic effect, thereby preventing the occurrence of arrosive bleeding, which is the most common cause of death in this category of patients. EACA is also an inhibitor of kinins (biogenic polypeptides formed in the body from alpha globulins under the influence of kallikrein), has anti-allergic activity, and inhibits the formation of antibodies. In addition, EACC increases the detoxification function of the liver, which is especially important in conditions of endotoxemia, and has an antienzyme effect [8].

 The method in comparison with the prototype has the following advantages - the abdominal cavity does not close tightly, moreover, it is drained by tubular drains, which improves blood circulation in organs and tissues and creates an oxygen-air environment, preventing the growth and reproduction of anaerobic microorganisms. In addition, decompression of the biliary tract is carried out, which improves the drainage function of the pancreas through the main pancreatic duct, relieves intraductal stress in the area of the large duodenal nipple, and allows dynamic monitoring of the state of the extra- and intrahepatic biliary tract using x-ray contrast studies.

 However, in a comparative analysis of the proposed method has significant differences, ensuring the achievement of a new effect.

 If the prototype uses a fibrous sorbent AUVM or hemosorbent, then the claimed method uses the natural mineral shivirtuin containing two active sorbents.

 If according to the prototype, the sorbent is not saturated with the drug composition, then in the claimed method, as a "rider" on the sorbent, an EACA is used, which has antienzyme and hemostatic properties, enhances the adsorption properties of the sorbent and prevents the development of arrosive bleeding.

 If, according to the prototype, the abdominal cavity in the interval between relaparotomies is closed by a mechanical zipper with a fastener, which leads to an increase in intra-abdominal pressure, deterioration of organ circulation, then an open omentobursopancreatostomy is formed in the claimed method and even placed containers with a sorbent do not increase intra-abdominal pressure and do not worsen organ blood.

 If the prototype does not use intraportal infusion and special therapy, then according to the claimed method it is carried out through a recanalized and catheterized umbilical vein.

 If the prototype does not use decompression of the digestive tract, then in the claimed method the digestive tract is drained by an enteral probe, which improves organ blood flow, lymphatic drainage from organs and tissues. The probe allows you to correct enteric insufficiency, carry out enterosorption, hypothermia of the stomach and intestines, inhibit gastric secretion and provides many other therapeutic measures.

 Thus, the use of a systematic approach in the treatment of pancreatic necrosis in the present method allows you to affect the focus of endotoxemia - necrotic pancreas - using sorbents placed throughout its area, and on secondary products that enter mainly the portal vein system by introducing appropriate drugs into the portal bloodstream .

 The inventive method involves the use as a sorbent of a natural dispersed mineral Shivirtuin. Shivyrtuin (TU 10 of the RSFSR 359-91) - montmorillonite-clinoptilolite-containing tuff, natural dispersed material of the Shivyrtuy deposit (South of the Chita Region, RF). Shivyrtuin includes zeolite (clinoptilolite) with a Moss hardness of 3.5–4 rel. units and white clay (montmorillonite) with a hardness of 1-1.5. Mass fraction of the sum of montmorillonite and clinoptilolite in the mineral is 80% or more. For clinical trials, samples were taken with a clinoptilolite content of at least 80%, montmorillonite in a volume of 10-15% of the total mass. This combination, as shown by tests, is optimal for medical purposes. Shivyrtuin includes a wide range of macro- and microelements, including copper, zinc, iron, cobalt, selenium. In crushed form, it is a relatively soft whitish-gray, sometimes with a yellowish tinge, homogeneous or slightly layered light breed. Shivyrtuin as a zeolite in the majority has a three-dimensional structure of alternating tetrahedra of silicon and aluminum oxides. Its cavernous structure determines the presence of a huge inner surface, reaching 47% and containing molecules with a diameter of 2.6 to 7-9 angstroms. The pores are filled with water and exchange cations. Together with water, they form an electrolyte-like mobile compound.

 Shivyrtuin has sorption, ion exchange, molecular sieve and catalytic properties. In sorption of endotoxins and heavy metals, it surpasses many domestic and foreign sorbents. It was established in the experiment that shivyrtuin increases the level of total protein in blood serum, reduces trypsin activity and does not affect amylase activity, regulates the composition of electrolytes in the body, affects the pH of the medium, reducing it from 8 to 5 units.

 The sorption capacity of shivyrtuin with respect to microorganisms is 1-2 orders of magnitude higher than that of other sorbents, which explains its ability to prevent dysbiosis and normalize the intestinal microflora, stabilizing intestinal homeostasis. It was found that interacting with microorganisms, shivyrtuin forms conglomerates, in which microbes are deprived of optimal living conditions, which reduces their invasiveness and they are easily removed from the cavities. In the processes of adsorption and ion exchange, shivyrtuin tends to selectively absorb certain molecules and ions. High dispersion determines the osmotic activity and ion-exchange ability of shivirtuin, as a result of which the diffusion of toxins slows down and weakens, and white blood cell migration to the wound is stimulated. Sorbent in its pure form and as a carrier of dosage forms has a whole set of positive properties: it has necrolytic, decongestant and anti-inflammatory effects in the first phase of the wound process, stimulates regeneration.

Heating to 100-120 ^o C allows you to free the mineral from water and microorganisms and, placing in a liquid drug mixture, saturate it with the necessary components, which in the lumen of the digestive tract or serous cavity come out of the pores.

 Of the identified deficiencies, the absorption of vitamin D and the growth of Candida fungi in the lumen of the digestive tract are essential for surgery, which is offset by the addition of appropriate drugs.

 In the experiments with shivirtuin, the phenomenon of tissue sorption detoxification was established, which is based on the extraction of toxic metabolites, microbial cells, toxins from the lesion. Sorption properties are manifested in tissue dehydration, in the specific adsorption of acid metabolites, which leads to an increase in the pH level in the lesion and, therefore, favorably affects the course of the pathological process, as well as potentiates the effect of drugs.

 The use of shivyrtuin in medicine, consisting of a mixture of clinoptilolite and montmorillonite in combination with succinic acid and thymol, as a bioenergy modulator for oral administration according to patent 2040270 is already known in medicine [9].

 The biostimulating effect of shivyrtuin in combination with succinic acid and an extract from oak branches is known when taken orally according to patent 2040269 [10].

 The proposed method treats 7 patients with pancreatic necrosis. The results of treatment are as follows: 6 people recovered, 1 patient died from arrosive bleeding, which is the most common cause of death in this category of patients.

 Clinical example 1. Patient Trofimov AN 44 years old, And B 2316, hospitalized 03/28/1997 with a diagnosis of pancreatic abscess, pancreatic necrosis. From the anamnesis it is known that he has been ill since 9.03.97 after alcohol abuse for 12 days. From 03/18/97 to 03/27/97 he was treated in a nodal hospital, transferred to a clinic with a picture of peritonitis. For 10 days, active anti-inflammatory, specific, detoxification therapy was carried out, the entire volume of clinical, laboratory and instrumental studies was carried out. Due to the failure of conservative therapy and an increase in peritonitis on 04/09/97, laparotomy, abdominal sanitation, intestinal intubation, cholecystostomy, umbilical vein catheterization were performed, omenobursopancreatostomy was formed, necsececrerectomy was performed along the head, body and tail gland, it is drained by two tubular drains through the right and left hypochondria, synthetic containers are placed in the stuffing bag throughout the pancreas tissue with shivirtuin and EAAC adsorbed on it. Throughout the week, programmed reorganization relaparotomies were performed daily with replacement of containers with sorbent and stage reorganization of the stuffing box. Drug therapy was carried out in full with the use of maximum doses of contracal, 5-fluorouracil, the entire spectrum of efferent treatment methods was performed. Since April 17, 1997, positive dynamics in the abdominal cavity was noted, its volume decreased, because of which only two containers were placed. Their change was made daily in the dressing room. On April 21, 1997, the sorbent was saturated with metronidazole and dioxidine. By May 14, 1997, the condition improved significantly, signs of endogenous intoxication were stopped, the umbilical vein catheter was removed, drainage was removed from the stuffing box, pancreatic fistula was formed, local sorption therapy was discontinued. They began to tampon the wound with ointment dressings. 05/30/97 the fistula was closed, the laparotomy wound healed by secondary intention. 1.06.97 was discharged in satisfactory condition. Examined after a year - healthy, set to work.

 Clinical example 2. Patient Naletov N.V. 34 years old, ИБ 2946, transferred on 04/14/99 from a departmental hospital with a diagnosis of pancreatic necrosis. From the anamnesis it is known that he fell ill acutely after drinking alcohol on 03/31/99. 04.04.99, in connection with unsuccessful conservative therapy, a laparotomy, cholecystostomy, drainage of the omental bursa and abdominal cavity were performed in the departmental hospital. In connection with the worsening condition of 04/04/99, relaparotomy, debridement, and abdominal drainage were performed. An ambulance car was delivered to DKB st. Chita-2, where complex conservative therapy with traditional methods has begun. 04/27/999 due to an increase in the peritonitis clinic - relaparotomy, necrosecestrectomy of the foci of pancreatic destruction, drainage of the omental bursa through the right and left hypochondria and lumbar access. 05/05/99, the fecal discharge was performed on the tube to the left of the stuffing bag, relaparotomy was performed under anesthesia, umbilical vein catheterization, naso-intestinal intubation, omenobursopancreatostomy was formed, containers with shivirtuin saturated with EAAC were placed in the stuffing bag. From 6.05. till 13.05.99 - daily programmed rehabilitation sanitation relaparotomy with replacement of containers with sorbent. By May 14, 1999, the stuffing bag was completely cleaned, peritoneosorption was stopped, the drains were removed, the wound was loosely plugged with ointment compositions. The tubular fistula functioned until 4.06.99. 06/06/99 early secondary sutures were applied to the laparotomy wound, with fistulography through the cholecystostoma - the common bile duct is passed, there are no calculi. The sutures from the wound were removed after 23 days, was discharged in satisfactory condition 06/30/99. Examined after 4 months - healthy, set to work in the specialty.

 Clinical example 3. Patient S. Letunova 36 years old, And B 2664 entered 3 h.o. 04/04/99 with a diagnosis of gallstone disease, chronic calculous cholecystitis, obstructive jaundice. 04.04.99 urgently under anesthesia - laparotomy, cholecystectomy, choledocholithotomy, choledochoscopy, drainage of the common bile duct and abdominal cavity. The postoperative period was difficult, the condition progressively worsened, postoperative pancreatitis was diagnosed on 04/20/99, the whole range of traditional methods of conservative therapy was carried out. However, on May 3, 1999, in connection with the developed clinic of peritonitis in an emergency, relaparotomy, rehabilitation, drainage of the stuffing box, pancreatic necrosis was diagnosed. After relaparotomy, the condition remained severe, there were no positive dynamics from the use of traditional methods of conservative therapy. In this connection, programmed relaparotomy, nasointestinal intubation, umbilical vein catheterization, necrosecestrectomy, pancreatic abdominization, stuffing bag drainage through tubular hypochondria, imento-bursopancreatostomy, and peritoneosorbent neurotransmission have been initiated. Over the next two days, programmed reorganization relaparotomies were performed with the replacement of containers with sorbent. 05/14/99 - arrosive bleeding from the stuffing bag, containers removed, made tight tamponade of the stuffing bag. After stopping the bleeding after 4 days, the tampons were replaced with containers with a sorbent with EAAC and metronidazole adsorbed on it. 05/25/99 the omental bursa is completely cleaned, peritoneosorption is complete, however, a lip-shaped fecal colonic fistula has opened in the wound. 05/27/999 under anesthesia - suturing of the lip-shaped colonic fistula, the imposition of early secondary sutures on the laparotomy wound. However, 12.06.99 - a relapse of fecal colonic fistula, its tubular variant was formed. The sutures were removed on 06/18/99, most of the wounds healed by first intention, at the request of the patient transferred to aftercare at the place of residence. Examined after 5 months - the fistula was closed, healthy, and started to work.

 Clinical example 4. Patient Markova G.I. 59 years old, And B 9134, was admitted on an emergency basis 12/20/99 with a clinic of peritonitis. Conservative therapy, preoperative preparation has begun. 12/21/99 - under general anesthesia - laparotomy, debridement and drainage of the omental bursa and abdominal cavity, nasointestinal intubation, cholecystostomy, umbilical vein catheterization, pancreatic abdomination was performed, omenobursopancreatostomy was formed. 23-24.12.99 - programmed debridement relaparotomy, peritoneosorption according to the claimed method - a state of extreme severity, unstable hemodynamics. 12/26/99 - Arrosive bleeding from an omental bursa. A relaparotomy was performed, the containers were removed, a tight tamponade of the stuffing bag was produced. The bleeding was stopped, but the condition progressively worsened, the clinic of endotoxemia was growing, and traditional complex methods of conservative therapy had no effect. 1.01.00 the patient died. In a pathological study, total pancreatic necrosis, endotoxic shock, acute cardiovascular failure, large branches of the splenic artery and vein are arrozed.

Sources of information
1. Savelyev V.S., Kubyshkin V.A. Pancreatic necrosis. Status and perspective. - Surgery, 1993. - 6. - S. 18-21.

 2. Auth. St. USSR 1313434 A1. A method for the treatment of acute pancreatitis. Karimov Sh.N., Kuzionov P.V. by application 05.20.85, cl. A 61 B 17/00 ,. BI 20.

 3. Auth. St. USSR 1344326 A1. A method for the treatment of pancreatic necrosis / Shalimov A.A., Shalimov S.A., Kozyryatov S.E., Shchitov V.S. by application 29.12.81, cl. A 61 B 17/00, BI 38.

 4. Auth. St. USSR 1581284 A1. The method of mobilization of the pancreas with pancreatic necrosis / Shilenok V.N., Kharkevich N.G., Leonovich S.I., Zeldin E.Ya., Sobol V.N. according to the application 18.12.87, cl. A 61 B 17/00, BI 28.

 5. Auth. St. USSR 1409233 A1. A method for the treatment of acute destructive pancreatitis / Gakov B.S., Nifantiev O.E., Maliglovka Yu.A., Fokin EA, Selezov EA by application 12.06.84, cl. A 61 B 17/00, BI 26.

 6. Auth. St. USSR 1243705 A1. A method for the treatment of acute destructive pancreatitis / Mamedov N.G., Chernov V.N., Shepotinovsky V.I. by application 11.11.84, cl. A 61 B 17/06, BI 26.

 7. Lopatkin N.A., Lopukhin Yu.M. Efferent methods in medicine (theoretical and clinical aspects of extracorporeal treatment methods). - M .: Medicine, 1989, 352, 137s.

 8. Reference Vidal - medicines in Russia. - M .: Astra-FarmService, 1997, B - 10.

 9. RF patent 2040270 Bioenergy modulator / Shepelenko A. M. By application 94036667/14. Claim 09/30/1995, BI 21.

 10. RF patent 2040269. Biostimulating agent / Shepelenko A.M., Podkolzin A.A., Dmitriev N.N. According to the application 94036666/14. Claim 09/30/1994, BI 21.

Claims (2)

 1. A method of treating pancreatic necrosis, including relaparotomy, sanitation of the abdominal cavity and omental bursa, drainage, pancreatic abdomination, peritoneosorption, characterized in that shivirtuin granules pre-saturated with a solution of 5% epsilon-aminocaproic acid in the ratio of 3 are used as sorbent: 1, and additionally carry out lymphostimulation and drainage of the gastrointestinal and biliary tracts.  2. The method according to claim 1, characterized in that the lymphostimulation is carried out by enhancing the lymphatic production of the liver, for which a hemodiluteant, for example reopoliglukin, is introduced through the recanalized umbilical vein, and through which intraportal antifermental infusion therapy is carried out.