RU2219867C2 - Method for treating necrotic tissues - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves treating tissue with high voltage electric discharge in aerosol jet mode. Necrotic tissue of pancreas and parapancreatic fat is treated by moving converter nozzle with exposure of 1-4 s/cm² with nozzle being 30-50 mm remote from pancreas and canamicin consumption rate being equal to 0.3-0.35 ml/s. Then, the cavity is dried and the tissue is coagulated with pulsating plasma jet at a rate of 2-5 cm/s at an angle of 20-30 deg from a distance of 15-20 mm to injured pancreas surface areas. EFFECT: enhanced effectiveness in performing combined healing and necrotomy treatment.

Description

 The invention relates to medicine and can be used in surgical operations on the pancreas.

A known method of processing a high voltage pulsed electric discharge (VER) of the abdominal cavity with peritonitis with an exposure of 0.02; 0.03; 0.05 s / cm ² . An increase in exposure to 0.1 s / cm ² leads to a violation of the permeability of the vascular walls and the detachment of mesothelial cells and their damage (Abstract of Stefanovsky V.G., candidate of medical sciences, 2000, p.20).

There is a method of treating peritonitis, which consists in exposure to VER in a jet-aerosol mode with an exposure of 3-4 c / cm ² , at a certain distance of the transducer nozzle from the surface of exposure and antibiotic consumption (Patent RF 2164421, publ. 27.03.01).

 The objective of the invention is to increase the effectiveness of treatment by removing degenerated substances.

The problem is solved in that in the method of processing necrotic tissue by exposing the tissue to VER in a jet-aerosol mode by moving the transducer nozzle at a distance from the affected tissue, exposure of the pancreatic necrotic tissue and parapancreatic tissue is carried out with an exposure of 1 to 4 s / cm ² at a nozzle distance from the pancreas of 30-50 mm and at a flow rate of kanamycin 0.3-0.35 mg / s, after which the cavity is drained and coagulated with a pulsed plasma jet during scanning the plasma torch at a speed of 2 to 5 cm / s at an angle of 20-30 ^o and at a distance of 15-20 mm to the surface of the affected areas of the pancreas.

 For the treatment of acute pancreatitis complicated by focal pancreatic necrosis, the authors propose a method for necrectomy by the effect of VER and pulsed plasma jet (IPA).

 At the first stage, electrohydraulic processing (EGO) of the affected areas of the gland is carried out with the Electron-1 device, which is a generator of high-voltage electrical pulses. It is connected through a flexible current lead to an EG converter, which ensures the distribution of secondary factors of the EG effect (electromagnetic field, ultrasonic waves and ultraviolet radiation) in the abdominal cavity. The converter is a rod opposing system with a discharge gap rod-cone. The maximum current of the discharge electric pulse is at least 500 A, the potential difference on the electrodes is 3-6 kW, the pulse duration is about 2 μs, the pulse PU is 1.25 μs, the pause is 0.35-0.47 s. The maximum pulse frequency is 70 hertz. The average number of pulses "one click" - 4.

 The method is as follows.

The pancreas with a focus of pancreatic necrosis is removed into the surgical wound and the VER is treated in a spray-aerosol mode with an exposure of the EG transducer of 1-4 s / cm ^{2 the} distance of the nozzle from the pancreas is 30-50 mm and the flow rate of kanamycin is 0.3-0.35 g / from. There is a process of "evaporation" of necrotic tissue. After that, the cavity is drained and proceed to the second stage: the formation of a dense coagulation film with the formation of intravascular thrombi, which is achieved using high temperatures of the plasma stream.

To obtain a plasma jet in a pulsed mode, an MPU-4 installation is used, with the following characteristics:
- adjustment of current pulses - 2.5-30 A,
- discrete adjustment of the duration of pulses and pauses - 0.02-0.5 s,
- the consumption of plasma-forming gas is 12-30 l / h,
- shielding gas flow rate - 120-240 l / h,
- temperature of an argon stream - 3000-4000 ^o C,
- jet diameter - 1.3 mm,
- jet length - 2.0 mm,
- gas pressure - 0.1-0.2 atm.

After EGO, the surgeon carries out the process of hemostasis of a pulsed plasma jet (IPS): the pendulum-like scanning movement of the plasma torch at a speed of 2-5 cm / s at an angle of 20-30 ^o from a distance of 15-20 mm treats the affected areas of the gland with the simultaneous coagulation of bleeding vessels to form a thin light brown crust of a coagulation scab, not allowing charring.

 After coagulation, the plasmatron is removed and the processing efficiency is evaluated and, if necessary, point coagulation is carried out.

 Subsequent actions are performed in a known manner (cholecystostomy, combined omentopancreatobursostomy with drainage of the omental bursa and retroperitoneal space with gauze and tubular drains, suturing of the wound to drains).

 The programmed processing of EGO VIER AND IPS is carried out for 5-6 days in the previous modes.

 The proposed method of combined necrectomy promotes the rapid removal of degenerated substances from the surface of the organ, improves microlymphatic drainage of tissues, which leads to the rapid transition of the stage of alteration and exudation to the proliferation stage.

 1. An example. Experiments were performed on 35 guinea pigs. The same number of animals were in the control group, where the rehabilitation of acute focal pancreatic necrosis was carried out by a known method.

 The total mortality in the control group was 27 animals (77%). The rest: in 5 - adhesions, in 1 - a cyst in the area of necrosis, in 2 - stony infiltrate.

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

 2. An example. Patient S., 28 years old, 04/05/2000 was admitted to the admission department of OGKB 1 with a diagnosis of renal colic on the left.

 After 12 hours from the moment of admission, laparoscopy was performed, in which acute edematous pancreatitis was detected. Performed drainage of the abdominal cavity.

04/06/00 operation: laparotomy. Cholecystostomy. Revision, rehabilitation of the pancreas and parapancreatic fiber using a combined EGO VIER in a jet-aerosol regime with an exposure of 1 s / cm ² in a solution of kanamycin 0.3 mg / s. The distance between the EG converter and the pancreas is 30 mm. Exudate evacuated. The areas of necrosis in the area of the body and tail of the pancreas of the IPS were processed at a plasma jet length of 2 mm, a current of 6 A, with a pulse and pause duration of 0.5 seconds, at a speed of 2 cm / s at an angle of 30 ^o from a distance of 15 mm to the formation of a light brown crust. Omentobursostomy. Lumbotomy. Drainage of the abdominal cavity and retroperitoneal space.

 04/11/00 a programmed relaparotomy was performed with revision and combined EGO of VER and IPS of the pancreas and parapancreatic fiber in the previous modes.

 04.19.00 the patient was transferred from the intensive care unit to the surgical department.

 04/30/00 a control MRI scan was performed, on which iron with sizes of 26 • 20 • 22 mm was detected, its contour was smooth, and its structure was homogeneous.

 05.05.00 the patient was discharged with recovery in satisfactory condition.

Claims (1)

A method of treating necrotic tissue by exposing the tissue to a high-voltage pulsed electric discharge in a spray-aerosol mode by moving the transducer nozzle at a distance from the affected tissue, characterized in that the exposure to the necrotic tissue of the pancreas and parapancreatic tissue is carried out with an exposure of 1 to 4 s / cm ² at a distance of the nozzle from the pancreas 30-50 mm, and with a flow rate of kanamycin 0.3-0.35 ml / s, after which the cavity is drained and coagulated with pulsed plasma tissue with by scanning the plasma torch at a speed 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 the affected areas of the pancreas.