Pancreatectomy and drainage

1. Acute hemorrhage, necrotizing pancreatitis with diffuse peritonitis, peritoneal exudate, non-surgical treatment is not good. 2. The original combination of biliary tract disease, after treatment is not good, it is necessary to remove the cause by surgery. 3. Patients with complicated abscesses or pseudocysts. Treatment of diseases: pancreatitis pancreatic cyst Indication 1. Acute hemorrhage, necrotizing pancreatitis with diffuse peritonitis, peritoneal exudate, non-surgical treatment is not good. 2. The original combination of biliary tract disease, after treatment is not good, it is necessary to remove the cause by surgery. 3. Patients with complicated abscesses or pseudocysts. Preoperative preparation Acute pancreatitis often complicated by acute diffuse peritonitis, resulting in imbalance of systemic water and electrolyte balance. Infusion and blood transfusion should be performed according to the condition before surgery to prevent infectious or hemorrhagic shock. In addition, pay attention to the use of antibiotics, calcium and analgesics. Surgical procedure 1. Incision: Generally, the right upper transabdominal rectus incision or the upper abdomen incision is used. The incision can smoothly enter the small omentum cavity, and the biliary tract can be explored when the biliary tract disease is combined. 2. Exploration: After entering the abdominal cavity, first explore. Acute hemorrhagic and necrotizing pancreatitis often have a large amount of bloody ascites. The omentum and tissues containing more fat often have pale yellow soapy necrotic lesions, which are helpful for diagnosis. In order to explore the pancreas, the omentum should be cut into the small omentum cavity, the stomach should be pulled upwards, and the transverse colon can be pulled down to reveal the pancreas. When the inflammation of the pancreas changes, it is often diffuse and swollen, with edema of the capsule, and there is scattered or large necrosis. Abscesses or pseudocysts may also occur in patients with longer course of disease. 3. Incision and drainage: acute hemorrhage, necrotizing pancreatitis, pancreatic capsule swelling, necrosis, the capsule should be opened and decompressed, so that blood supply can be improved, reduce necrosis, prevent the disease from worsening, but the cut should not be too deep. When the capsule is incision, it can be bluntly separated along the capsule with a finger or a hemostatic forceps to avoid injury to the pancreatic duct and cause pancreatic fistula. Under normal circumstances, it is necessary to set up the colleague's hose to guide the drainage. The drainage tube should be taken out from the upper, lower or left and right incisions of the other puncture to ensure the healing of the abdominal incision. It has been argued that extensive and deep incisions are made along the long axis of the pancreas. The obvious focal necrotic area was scraped to remove necrotic pancreatic tissue, and multiple drainages were placed around the pancreas and in the pancreatic bed area. If necessary, place deep pit drainage, and postoperative abdominal lavage can improve the survival rate. 4. Exploring the biliary tract: More than half of the patients had biliary tract disease, so it is necessary to carefully explore the biliary tract, and according to the findings, consider the common bile duct incision drainage or gallbladder ostomy.