UA10802U - Surgical treatment of chronic pancreatitis complicated with cyst - Google Patents

Abstract

The surgical treatment of the chronic pancreatitis complicated with the cyst is performed in two stages. The first stage comprises transcutaneous draining of the cyst with trocar under sonographic control. The local lavage is also performed. The second stage consists in resecting the chronically altered tissue of pancreas and dissecting the walls of the residual cyst cavity. The concrements of the duct and parenchyma are removed and pancreojejunostoma is applied.

Description

Description of the invention

The method relates to medicine, namely to surgery of digestive organs. 2 In case of chronic pancreatitis complicated by retention cyst or chronic pseudocyst, open laparotomy interventions are used.

Open laparotomy interventions consist in performing resection or drainage operations.

Of the resection operations, the method consisting of laparotomy, distal resection of the pancreas with a cyst is most often used, and when the latter is located in the head of the gland, performing 710 gastropancreatoduodenal resection with the formation of a pancreatojejunostomy, as well as choledochojejunostomy and gastrojejunostomy. Shalymov A.A., Shalimov S.A., Nychytaylo M.E., Radzyhovsky A.P. Surgery of the pancreas. - Simferopol. Tavrida, 1997. - P.170-1711.

The mentioned method refers to direct surgical intervention on the PZ, which allows to remove the cyst, but it is traumatic, long, technically difficult and accompanied by high postoperative mortality. Method 79 does not allow to remove only chronically changed areas, but also involves the removal of healthy tissue of the pancreas, which leads to a pronounced insufficiency of the exo- and endocrine functions of the pancreas in the distant period. The method does not allow to perform internal drainage of the ductal system, to remove calculi of the PZ, which leads to the progression of the disease, recurrence of cysts and pain syndrome. It is impossible to perform resection of the PZ in case of large cysts, which forces to perform operations of internal drainage of the cyst.

The method of internal drainage of the cyst by performing a cystojejunostomy is the closest in terms of features to the proposed one | Shalymov A.A., Shalimov S.A., Nychytaylo M.E., Radzyhovsky A.P. Surgery of the pancreas. - Simferopol. Tavrida, 1997. - P.170-171). At the same time, a laparotomy, indirect internal drainage of the ductal system of the pancreas is performed, which is carried out by applying a cystojejunostomy, which consists in the formation of a confluence between the cyst wall and the long loop of the small intestine with an interintestinal confluence according to Brown and plugging of the adductor loop according to O.A. Shalimov. in

This method has the following disadvantages: 1. Pancreatic cyst is not eliminated. 2. It is impossible to remove chronically changed areas and calculi of the pancreas.

Q. It is not possible to perform direct internal drainage of the ductal system of the PZ. high school

These deficiencies lead to recurrence of the cyst, pain syndrome, and progression of the disease. Ha")

The basis of a useful model is the task of creating such a method of treatment of chronic pancreatitis complicated by a cyst, which would prevent recurrence of the cyst, pain syndrome, progression of the disease by eliminating the cyst, ensuring direct internal drainage of the ductal system of the pancreas. Ha")

The task is carried out due to the fact that in the method, which includes a laparotomy and direct internal drainage of the ductal system of the PZ, the treatment is carried out in two stages: in the first stage, percutaneous external drainage of the cyst with a trocar under ultrasound control with local lavage is performed, and in the second stage stage - resection of the pancreas with the residual cyst cavity, calculi are removed and a pancreatojejunostomy is formed. "

The method is shown in the pictures. From 50 Fig.1. Percutaneous external drainage of a pancreatic cyst under ultrasound control. c 1 - cyst;

From" 2 - drains;

C - pancreas.

Fig. 2. Residual cyst cavity after external drainage under ultrasound control. 4 - residual cyst cavity; - 2 - drains; av | C - pancreas.

Fig. 3. Resected pancreas with pancreatojejunostomy. because Z - resected pancreas; aw! 20 5 - small intestine; 6 - duodenum; at 7 - pancreatojejunostomy.

The method is carried out as follows: at the first stage, external percutaneous drainage of the pancreatic cyst is performed with tubes through the anterior abdominal wall under ultrasound control with a trocar under 29 local anesthesia (Fig. 1). In the postoperative period, local lavage with antiseptic solutions is performed. c This allows you to significantly reduce the cavity of the cyst, repair it in case of healing (Fig. 2). As a result of the first stage, conditions are created for performing a direct combined operation on the PZ, which combines the properties of resection and drainage intervention.

At the second stage, a laparotomy is performed, a longitudinal dissection of the ventral surface of the pancreas along with the main 60 pancreatic duct along the entire length of the latter. At the same time, dissection of the residual cyst cavity is performed.

Next, resection of the chronically changed tissues of the pancreas with excision of the walls of the main pancreatic duct and the walls of the residual cyst cavity is performed. If ductal and parenchymal calculi are present in the gland, the latter are removed. The operation ends with the formation of a pancreatojejunostomy on the loop of the small intestine with a double-row suture (Fig. 3). This allows you to remove the cyst, perform direct internal drainage of the ductal system of the PZ, remove chronically changed areas and concretions of the PZ, prevent recurrence of the cyst, pain syndrome, and progression of the disease.

Example 1

Patient M., 55 years old (medical history Mo1350), 03/04/200Zr. came with complaints of constant intense pain in the upper abdomen, nausea, weakness, weight loss of 22 kg. for the last 8 months. Objectively: in the epigastrium, a round painful stationary mass with clear contours up to 1Osm is palpated. in diameter.

Conclusion of an ultrasound examination (USD): Chronic calculous fibrocystic degenerative pancreatitis. Dilation of extrahepatic bile ducts.

Clinical diagnosis: Chronic calculous fibrocystic degenerative pancreatitis. 70 At the first stage of treatment, percutaneous external drainage of the PZ cyst was performed under ultrasound control. Under local anesthesia under ultrasound control, through the anterior abdominal wall in the epigastric area, the cavity formation of the PZ was drained from two points with a trocar.

Postoperative diagnosis: Chronic calculous fibrocystic degenerative pancreatitis.

In the postoperative period, local lavage with antiseptic solutions was performed.

At the second stage of treatment, resection of chronically changed tissues of the gastrointestinal tract, removal of calculi, and pancreatojejunostomy were performed. During the operation: a midline laparotomy was performed in the epigastrium, longitudinal dissection of the ventral surface of the pancreas along with the main pancreatic duct along the entire length of the latter with simultaneous dissection of the residual cyst cavity. Resection of the chronically altered pancreatic tissues was performed with excision of the walls of the main pancreatic duct and the walls of the residual cyst cavity. At the same time, multiple ductal and parenchymal calculi up to 4 mm and 1-2 mm in size were removed, after which the flow of light pancreatic secretion from the lobular ducts of the left ventricle was noted. The operation is completed by forming a pancreatojejunostomy on the loop of the small intestine with a double-row Egeu suture.

Postoperative diagnosis: Chronic calculous fibrocystic degenerative pancreatitis.

Discharged in satisfactory condition. Examined after a year: no complaints, satisfactory condition, working capacity 2h Restored. No recurrence of the cyst was noted during ultrasound.

Example 2 -

Patient K., 38 years old (medical history Mob108), September 7, 2004. came with complaints of constant pain in the epigastrium with radiation to the back, nausea, weakness, weight loss of 14 kg. over the past 6 months, an increase in body temperature up to 37.59C. Objectively: the stomach is painful in the upper parts. Ultrasound conclusion: p

Chronic fibrocystic degenerative pancreatitis. Dilation of the main pancreatic duct.

Clinical diagnosis: Chronic fibrocystic degenerative pancreatitis. -

At the first stage of treatment, percutaneous external drainage of the PZ cyst was performed under ultrasound (Ge) control. Under local anesthesia under ultrasound control, through the anterior abdominal wall in the epigastric area, the cavity formation of the PZ was drained from two points with a trocar. -

Postoperative diagnosis: Chronic fibrocystic degenerative pancreatitis. "-

In the postoperative period, local lavage with antiseptic solutions was performed.

At the second stage of treatment, resection of chronically changed tissues of the pancreas, removal of calculi, and pancreatojejunectomy were performed. During the operation: a midline laparotomy was performed in the epigastrium, a longitudinal dissection of the ventral surface of the pancreas together with the main pancreatic duct with a simultaneous dissection of the residual cyst cavity. The main pancreatic duct is dilated dobsm. Resection of chronically changed tissues in the head of the pancreatic duct with excision of the walls of the main pancreatic duct and the walls of the residual cyst cavity was performed. The operation is completed by the formation of a pancreatojejunostomy on the loop of the small intestine with a double-row Vedeg suture. "" Postoperative diagnosis: Chronic fibrocystic degenerative pancreatitis.

Discharged in satisfactory condition. Examined after 5 months: no complaints, satisfactory condition, working capacity

Restored. No recurrence of the cyst was noted during ultrasound. - So, the proposed method allows to perform a direct drainage operation on the PZ with the elimination of the cyst, direct internal drainage of the ductal system, removal of chronically changed areas of the pancreas due to the fact that instead of applying a cystojejunostomy, a combined

Ho) surgical treatment: external percutaneous drainage of the cyst under ultrasound control followed by surgical intervention on the pancreas in the form of resection of its chronically changed tissues with a residual cyst and performance of a pancreatojejunostomy.

Co.)

Claims (1)

The formula of the invention A surgical method of treating chronic pancreatitis complicated by a cyst, which includes laparotomy, direct internal drainage of the ductal system of the pancreas, which is distinguished by the fact that the treatment is carried out in two stages: in the first stage, external percutaneous drainage of the cyst with a trocar is carried out under ultrasound control with local lavage. and at the second stage, resection of chronically changed tissues is performed 60 of the pancreas and excision of the walls of the residual cyst cavity, ductal and parenchymal calculi are removed and a pancreatojejunostomy is applied. b5