SU1676600A1 - Method for treatment of destructive pancreatitis - Google Patents

Abstract

The invention relates to surgery and can be used in the treatment of patients with acute destructive pancreatitis. The purpose of the invention is to reduce the number of postoperative complications by isolating the pancreas from the free abdominal cavity and retroperitoneal space. After laparotomy, dissecting the transverse colon, sanation of the pancreas and omentum. mobilization of the pancreas is performed, V-shaped ribbons from the dura mater are brought under it, their retroperitoneal fa is fixed tion, and the free ends positioned below the stomach and above the transverse colon, is output outward and fixed to the aponeurosis and skin. The method allows to increase the efficiency of treatment of patients with destructive pancreatitis. Recommended in practical medicine

Description

The invention relates to surgery and can be used in the treatment of purulent pancreatitis.

The purpose of the invention is to reduce postoperative complications by isolating the pancreas from the free abdominal cavity and retroperitoneal space.

The method is carried out as follows.

Laparotomy is performed. The stuffing box is opened by cutting the gastric colon, the pancreas is exposed and mobilized along the lower and upper edges. The pancreatic cavity of the small omentum is reorganized, the abdominal cavity is harvested. V-shaped under the mobilized pancreas, fixed to the retroperitoneal or pararenal fascia. The free edges of the ribbons are pulled out under the stomach and above the transverse colon to fix them to the aponeurosis and skin.

Example Sick K, 42 years old Diagnosis acute destructive pancreatitis. The anterior abdominal wall is dissected in layers by upper transverse accession. The gastro-rim of the mobilization of the 12-n to the Cocher is dissected throughout the entire course. The revision revealed that the body and tail of the pancreas were subjected to purulent fusion. Necrectomy was performed with removal of up to 80% of the pancreas. About 900 ml of purulent hemorrhagic contents were evacuated. The abdominal cavity was flushed with a 0.5% aqueous solution of chlorhexidine. The main pancreatic duct was transferred. Stopping bleeding In the area of the omentum, parietal peritoneum, multiple steatonecrosis

ABOUT

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The gall bladder contains calculi, its walls are thickened. Cholecystectomy. Holeoh is up to 0.9 cm in diameter and does not contain when revising concretions. External drainage of the choledoch by Pikovsky through the cult of the cystic duct. Then, under the stump of the pancreas, one ribbon was held 30 mm wide, 500 mm long, prepared in advance from the preserved dura mater of the corpse, one end was placed under the stomach, the other - transversely into the colon, and then they were separately stitched to the parietal peritoneum and aponeurosis of the upper edge of the wound, thus created a wound channel. Gauze tampons and glove-pipe drains, as well as micro irrigators of antiseptic solutions were introduced into the formed cavity alternately. Postoperative wound sutured to drainage.

The postoperative period was mild. At the same time, conservative treatment was carried out - infusion therapy, vitamins, phenoptin, antispasmodics, anti-biotic therapy. From the first day the patient was on parenteral nutrition. An abundant amount of sero-purulent discharge was released through the drains. Three times a day, dressings were made with washing of the drainages with furacilin, an aqueous solution of chlorhexidine. 450 500 ml of bile was discharged through Pikovsky drainage. There is no effect from the treatment being performed; the general condition of the patient did not have ynymia. Pains in the postoperative wound area, general weakness continued to bother. A pulse of 104 beats per minute, satisfactory filling and voltage. Aus-culture in the lower parts of both lungs weakened vesicular respiration. Body temperature 38.2 - 39.4 °. Palpation cutting pain in the mesogastric abdomen. Complete blood count: leukocytes 14x10, shift the formula to the left, ESR 65 mm / h, blood sugar 10 mmol / l. The activity of blood amylase 30 g / tsp., Lipase 32.2 mmol / tsp., Potassium 3.2 mol / l, sodium 140 mmol / l, total protein 52.9 g / l.

Considering the severity of the patient's condition, the lack of positive dynamics, it is allowed on the 4th day under intravenous ketamic anesthesia to perform repeated planned surgery with a non-cractomy of the remaining pancreas and parapancreatic fiber, washing the pancreato-duodenal area with antiseptic solutions. Conducting pancreatonecrectomy and sequestrectomy was blocked by the formation of a wound channel created by the supply tape. Gauze tampons and glove-rubber drainages were supplied, as during the initial surgical intervention. Subsequently, conservative treatment was carried out, washing drains with antiseptic solutions, daily dressings. The amount of drainage separated did not decrease.

The general condition of the patient improved, the pain in the postoperative wound area decreased, but the general weakness and poor appetite continued to disturb. Pulse 98 beats per 1 min., Rhythmic, satisfactory properties. Body temperature 37.2 - 37.9 °. In the lower parts of the lungs weakened vesicular respiration. Palpation tenderness around the postoperative wound. Complete blood count: leukocytes 15.0 x109, the formula formula shift, ESR of 63 mm per hour. Blood sugar 11 mmol / l, lipase 28.2 mmol / hl, blood amylase activity 26 g / h. Potassium 3.7 mmol / l. sodium 143 mmol / l, total protein 69 g / l, urea 8.5 mmol / l, residual nitrogen 4.0 mmol / l, chlorine 93.2 mmol / l. Pikovsky's drainage releases up to 720 ml of light bile per day. Despite the subjective improvement, the patient's condition remains heavy. For 9 days, under intravenous catemic anesthesia, a scheduled re-examination of the pancreato-duodenal area was performed, the surrounding necrotic tissues were removed, the streaks were opened, and antiseptic solutions were removed. At the same time, conservative therapy continued, aimed at correcting the body's metabolic processes. Daily dressings and washing of the open drainage cavity with antiseptic solutions were carried out.

In the future, the patient's condition improved, the pain decreased significantly, according to the appetite. On the 20th day, the temperature returned to normal. Pulse 82 beats per 1 min. Urinary diastase 64 units, ESR of 52 mm per hour.

In the subsequent treatment of the postoperative wound was carried out by the open method: daily dressing, washing with antiseptic solutions, ointment dressings. On the 17th day, the drainage along Pikovsky was removed from the choledoch.

Healing of wounds by secondary tension. On the 36th day was discharged for outpatient treatment. Using the proposed method made it possible to perform repeated surgical interventions with minimal tissue trauma.

Viewed through 1.5 g. Works by specialty.

5 16766006

The method is recommended for treatment with the fact that, in order to reduce postoperative destructive pancreatitis. Complications by isolating the formula of the invention of the gastric gland from the free abdominal

A method for the treatment of destructive punk cavity and retroperitoneal space,

reatitis, including laparotomy, stripes from the cerebral medulla of the gastrointestinal ligament are spread, the ligaments are fixed and fixed behind the pancreatic

reorganization of the pancreas and omentum, and the ends of them are brought out, where

howling of the bag, laparotomy, distinguishing-fix to aponeurosis and skin.

Claims (1)

Claim A method of treating destructive pancreatitis, including laparotomy, section of the gastrointestinal ligament, sanitation of the pancreas and omental bursa, laparotomy, characterized in that, in order to reduce postoperative complications by isolating the pancreas from the free abdominal cavity and retroperitoneal space, strips from the dura mater are brought in and fixed behind the pancreas, and their ends are brought out, where they are fixed to the aponeurosis and skin. Compiled by T. Dyuzheva Editor A. Dolinich Tehred M. Morgenthal Corrector A. Osaulenko Order 3061 Circulation Subscription VNIIIPI of the State Committee for Inventions and Discoveries under the State Committee for Science and Technology of the USSR 113035, Moscow, Zh-35, Raushskaya nab., 4/5 Production and Publishing Plant Patent, Uzhgorod, Gagarin St. 101