RU2191608C2 - Method for draining omental bursa in the cases of pancreonecrosis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves setting tubular drainage system. Penetrating draining is carried out using two parallel tubes with a set of lateral openings. The draining is carried out through the left lumbar cut, retroperitoneal space, and superolateral transmuscular incision of the anterior abdominal wall. Flow lavage through draining tubes is carried out. EFFECT: enhanced effectiveness of all pancreas parts lavage. 3 dwg

Description

 The invention relates to medicine, namely to surgery, and can be used in the treatment of pancreatic necrosis.

 A known method of drainage of an omental bursa in pancreatic necrosis with “blind” drainages introduced into the omental bursa through small sections of the abdominal wall in the right and left hypochondria with flow-aspiration drainage through them (Savelyev BC Guidelines for emergency surgery of abdominal organs. M .: Medicine, 1986, pp. 366-369; V. Chernov et al. On the issue of improving drainage and flow washing of the retroperitoneal space in pancreatic necrosis // First Moscow International Congress of Surgeons. Moscow, 19 95, p. 190 - 192.

 Method V.N. Chernova et al. (1995) was taken as a prototype, since there are common signs with the claimed object: during the operation, the stuffing bag is drained by drains introduced through separate incisions in the left and right hypochondria with flow washing of the stuffing bag after surgery.

Significant disadvantages of the prototype are:
1. Drainage of the stuffing bag with “blind” drains does not allow changing their position during treatment or changing them to tubes of different diameters.

 2. “Blind” drains can become clogged by tearing sequesters, fibrin and cease to function adequately.

 3. “Blind” drains do not allow effective flow washing of the stuffing bag on all affected areas of the pancreas (pancreas).

 4. "Blind" drainage, introduced into the stuffing bag for a long time for flow-through washing, increases the risk of gastrointestinal fistula formation and bleeding from the pancreas due to pressure sores.

 The essence of the claimed method consists in conducting two through parallel drainage tubes with many lateral openings through the left lumbar incision, retroperitoneal space, stuffing bag, abdominal cavity, right upper lateral granule muscular abdominal wall outward for them to be carried out after the flow washing operation.

 The method is as follows. During surgery for pancreatic necrosis, the stuffing bag is opened by dissection of the gastrointestinal ligament. After revision of the pancreas and necrectomy in the left lumbar region in the projection between the anterior and posterior axillary lines, a lumbotomy 3 of 5 cm length is performed with a section of the parietal sheet of the peritoneum (Fig. 1). Through this incision, the retroperitoneal space behind the splenic corner of the colon into the stuffing bag from the outside is injected with two PVC tubes with a diameter of 10-12 mm with many side holes, laying them in parallel along the front 1 and lower 2 surfaces of the pancreas from the tail (A) to its head (B ) Drainage tubes are removed through a small incision in the gastrointestinal ligament near the hepatic corner of the colon with their removal through the abdominal cavity into the right upper lateral granmuscular section of the abdominal wall 4 cm long outward and the ends of the drainage to the skin are fixed on both sides, and the integrity of the gastrointestinal ligament is restored separate interrupted sutures. Additionally, the abdominal cavity is drained with drainage tubes 5, 6 and glove rubber drainages 9 (FIG. 2). In cases of a combination of pancreatic necrosis with peritonitis from the lateral transmuscular sections, left and right drain the lateral canals of the abdominal cavity 7, 8, the right subhepatic, left subphrenic spaces, the pelvic cavity, and the abdominal cavity is sutured (Fig. 3). In the postoperative period, through the “through” drainages connected to the active aspirator, flow-through washing of the stuffing box and retroperitoneal space is carried out.

 The method is used in the treatment of patients with pancreatic necrosis in the Samara Regional Clinical Hospital. M.I. Kalinin.

 Example 1. Patient G., 27 years old, and / b 12716, 07/19/96, was operated on by the Central Clinical Hospital for hemorrhagic pancreatitis of the body and tail of the pancreas with drainage of the omental bursa through cuts in the right and left hypochondria, transferred to OKB. 07/22/96, relaparotomy, necrectomy from the body and tail of the pancreas was performed, phlegmon of the retroperitoneal space was opened. The operation was completed through the drainage of the stuffing bag with two tubes according to the described method. In the postoperative period, intensive anti-inflammatory and antibacterial therapy was carried out, flow-through washing of the stuffing box with antiseptic solutions for 30 days, followed by fractional washing of it for another 14 days. The symptoms of pancreatitis were stopped, the drainage was removed, and on September 23, 1996, the patient was discharged for outpatient treatment in a satisfactory condition.

 Example 2. Patient K., 28 years old, and b 48582 was operated on an emergency basis on 23.11.97 for a thoracoabdominal knife wound with damage to the diaphragm and pancreas. November 30, 1997 the patient was transferred to the design bureau in connection with the deterioration. 12/03/97, Relaparotomy 1, necrectomy from the body and tail of the pancreas, drainage of the omental bursa with two through drainages according to the described method. On December 9, 1997, in connection with the occurrence of bleeding from the pancreatic bed, relaparotomy 2 was performed, during which it was established that the phenomena of post-traumatic pancreatitis were stopped and the bleeding was caused by the sequestration leaving the pancreas body. As a result of the treatment with flowing washing of the stuffing bag through "through" drainages, the patient's condition returned to normal, and on 01/26/98, he was discharged for outpatient treatment in satisfactory condition.

 The applied method of drainage of the stuffing box in pancreatic necrosis has improved the results of treatment of patients and reduce mortality.

Thus, the significant advantages of the proposed method for through drainage of the stuffing box during pancreatic necrosis in comparison with the prototype are:
1. The possibility of displacement of the probe along the length and its replacement during treatment with probes of larger or smaller diameters.

 2. Drainage of the stuffing bag through through the drainage reduces the risk of bleeding from the pancreatic tissue and the formation of gastrointestinal fistulas.

 3. Through drainage of the stuffing box in pancreatic necrosis according to the described method allows effective lavage of all departments of the pancreas.

Claims (1)

 A method of drainage of the stuffing bag in pancreatic necrosis by installing a tubular drainage system, characterized in that, in order to ensure optimal drainage of the pancreas and retroperitoneal space and to obtain the possibility of changing the position of the drainage and replacing the tubes, through drainage is carried out through two parallel tubes with many side holes through left lumbar incision, retroperitoneal space, abdominal cavity, upper lateral transmuscular incision of the anterior abdominal wall with the last flowing washing through them.

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