UA64959A - Method for treating pancreatonecrosis - Google Patents

Abstract

The method for treating pancreatonecrosis provides for the blood flow correction by means of the reduction of splenic blood flow. The catheter for the intra-arterial antibiotics is inserted into the superior mesenteric artery.

Description

The invention relates to medicine, namely surgery, and can be used in emergency pancreatology.

A known method of surgical treatment of pancreatic necrosis includes correction of blood supply to the pancreas. The essence of the method is that after ligation of the main branches and the splenic artery itself, an increase in the main and collateral blood circulation in the pancreas is noted (see N.A. Mutalibov, I.Ya. Kachalina.

An increase in arterial inflow to the pancreas in an experiment. / The abstracts of reports Hi! congress of surgeons of Transcaucasia. - Yerevan, 1998. - P. 383-384).

The disadvantage of this method is that the spleen is removed and the number of branches of the splenic artery supplying the pancreas with blood decreases, which can lead to various postoperative complications (abscess, bleeding), and in the case of thrombosis of the branches of the remaining splenic arteries, necrosis of the pancreas.

The closest to the proposed method is the method of surgical treatment of pancreatitis | see application

of the Russian Federation Me94001968, IPC Ab1817/00). The above-mentioned method includes the correction of blood supply to the pancreas by taking a segment of the great saphenous vein of the thigh, preparing an autovenous shunt and using it to make an anastomosis between the aorta and the splenic artery, as well as between the aorta and the hepatic artery.

This method increases arterial blood flow to the pancreas, but the effectiveness of this method is still insufficient, mainly due to high trauma due to laparotomy access, long surgical intervention and the postoperative period, the impossibility of performing it in patients with accompanying diseases of the cardiopulmonary system.

The invention is based on the task of treating pancreatic necrosis by increasing the arterial blood flow to the pancreas and introducing antibacterial agents directly to the necrosis foci to prevent complications of pancreatic necrosis, such as bleeding and suppuration.

This task is solved by the fact that in the method of treating pancreonecrosis, which includes the correction of blood supply to the pancreas, according to the invention, the correction of blood supply is carried out by X-ray endovascular reduction of splenic blood flow, and a catheter is inserted into the superior mesenteric artery for intra-arterial antibiotic therapy, and then the foci of necrosis are drained laparoscopically.

X-ray endovascular reduction of splenic blood flow is performed with the help of Gianturco spirals.

The causal relationship of the proposed differences is as follows.

X-ray endovascular reduction of blood flow through the splenic artery, regional antibiotic therapy directly into the superior mesenteric artery, as well as laparoscopic drainage of necrosis foci create the most optimal conditions for increasing arterial blood flow to the pancreas and reducing postoperative complications without unnecessary traumatization of the organ. The invention is explained with a drawing.

Fig. 1 shows the blood supply of the pancreas in patients with pancreatic necrosis in the region of the tail of the pancreas before correction.

Figure 2 shows the blood supply of the pancreas in patients with pancreatic necrosis in the tail of the pancreas after correction.

The drawings indicate:

GDA - gastroduodenal artery;

Che - abdominal trunk;

SA - splenic artery;

A - aorta;

LV - left gastric artery;

VBA - superior mesenteric artery;

VPA - own hepatic artery;

ZPA - common hepatic artery.

The method is carried out as follows.

Under local or intravenous anesthesia according to the Seldinger method, catheterization of the abdominal aorta is performed via a transfemoral or transaxillary approach. Catheterization of the abdominal trunk is performed under X-ray television control using catheters of the "Sobga" or "New!" type. for vascular branches of the abdominal artery. After catheterization of the abdominal trunk, serial coeliacography with a contrast agent (triobrast, ultravist) is performed with obtaining the arterial parenchymal and venous phases of contrast. Correction of blood supply is carried out simultaneously. After studying the arteriographic data in patients with pancreonecrosis and the localization of the pathological process in the body and tail of the pancreas, in order to prevent bleeding and reduce the postoperative complications of pancreonecrosis, blood flow reduction in the basin of the splenic artery is performed.

Next, the catheter is superselectively guided from the abdominal trunk to the splenic artery along the conductor.

Reduction of splenic blood flow is performed with the help of metal spirals of the Hiaturko type, which are inserted under X-ray television control through a diagnostic catheter into the opening of the splenic artery (in its proximal or middle part, before the departure of the branches that supply blood to the tail of the pancreas). Then the catheter is lowered into the abdominal aorta and catheterization of the upper mesenteric artery is performed for subsequent intra-arterial regional antibiotic therapy. Next, under general anesthesia, trocars are inserted into the abdominal cavity at 4 standard points. Pancreas inspection is performed under video surveillance. Then laparoscopically, the foci of necrosis and the omentum bag are drained with silicone tubes.

Example. Patient S., 50 years old, was hospitalized with symptoms of acute non-infected pancreatic necrosis 5 days after the disease. Clinical symptoms are confirmed by ultrasound data - the pancreas is enlarged, peripancreatic infiltrate, mainly in the tail of the pancreas. The level of E-amylase is 83 units, bilirubin is 10 μmol/l, leukocytosis is 12x109/l. Over the course of 20 hours, the infusion of antispasmodics, 400,000 units of Gordox, analgesics, and microcirculatory drugs did not improve the patient's condition, and symptoms of peritonitis appeared. Under internal anesthesia according to the Seldinger method, the abdominal aorta was catheterized through the left femoral artery; further under X-ray television control - the abdominal trunk. An angiographic examination revealed increased arterial inflow and hypervasculature of the tail and body of the pancreas. Pancreatoduodenal artery is enlarged in diameter, the internal arteries of the gland are twisted. In the parenchymal phase, an intensive accumulation of contrast material was revealed, especially in the body and tail of the pancreas, as well as foci of inhomogeneous contrast with uneven contours (foci of pancreatic necrosis) in the tail of the pancreas. The latter has increased in size. The catheter was superselectively advanced from the abdominal trunk to the splenic artery along the guide, blood flow was reduced using a Gianturco spiral. The catheter was lowered into the abdominal aorta and the upper mesenteric artery was catheterized, into which 1 g of the antibiotic amikacin was injected. Video laparoscopy was performed under general anesthesia. 500 ml of fibrinous and hemorrhagic exudate was evacuated, then the peritoneum under the gland was dissected, slight bleeding was noted, and coagulated. The gland is in a state of hemorrhagic and fatty pancreatic necrosis. The omentum bag, left flank and small pelvis were drained with silicone tubes. After 2 days, the symptoms of peritonitis subsided, leukocytosis and amylase level decreased. After 10 days, the patient was discharged in a satisfactory condition.

Due to the application of this method, an increase in arterial blood flow to the pancreas (head, body) from the basin of the gastroduodenal and superior mesenteric arteries, a decrease in blood flow through short arteries supplying blood to the tail of the pancreas, in combination with intra-arterial antibiotic therapy, is ensured, which lead to a decrease in inflammatory phenomena in the tail of the pancreas glands and prevention of postoperative purulent complications. In addition, necrotic tissues are removed laparoscopically, minimally traumatically. and I 4 for / in

Already - 7: we For VBA g; laziness still;

SAMA nya ah inapstev and "horn! where in a -- give 4: ше; ke 7" in so, cha ih pnonki

A and MA about 1B5A and ; about Spiral

WHEN WHERE nnninnme | : Gianturko VigI

Claims (2)

1. The method of treating pancreatic necrosis, which includes the correction of the blood supply of the pancreas, which differs in that the correction of the blood supply is carried out by X-ray endovascular reduction of the splenic blood flow, and a catheter for intra-arterial antibiotic therapy is inserted into the superior mesenteric artery, and then the foci of necrosis are drained laparoscopically. 2. The method of treating pancreatic necrosis according to claim 1, which differs in that X-ray endovascular reduction of splenic blood flow is carried out with the help of Gianturco coils.