Das Laparostoma in der chirurgischen Behandlung der hämorrhagisch-nekrotisierenden Pankreatits

Abstract

Treatment results of necrotising pancreatitis between 1982 and 1992 are reported. During the study period the management of necrotising pancreatitis was supplied by the laparostoma therapy. Within a standardised range of indications 118 patients with stage II and III of the disease were operated. The operative technique included distal pancreatectomy, necrectomy and debridement of the head of the pancreas. Among 72 patients (61.0%) a laparostoma treatment was applied, in 46 patients (39%) the abdominal cavity was closed post-operatively. A subsequent peritoneal lavage by stages was conducted within the laparostoma therapy group, in the other group the relaparotomy ensued from the clinical course. Although the degree of disease severity was more serious in the laparostoma group, the lethality rate could be reduced during the study period down to 21.4%. The lowest lethality rate was achieved by an operation after the 15th day of treatment.

Pankreaschirurgie am Knappschaftskrankenhaus Bochum-Langendreer zwischen 1975 und 1996

“…Die akute Pankreatitis fu È hrt neben den lokalen entzu È ndlichen Vera È nderungen an der Bauchspeicheldru È se auch zu einer systemischen [3]. Der Vorteil des Verfahrens liegt in der fru È hen Erkennung und Ausra Èumung weiterer Nekrosen, die mo È glichst schonend digitoklastisch entfernt werden, sowie einer rechtzeitigen Behandlung sich manifestierender weiterer Organkomplikationen und in der mechanischen Dekontamination und Detoxikation der Bauchho È hle durch eine intensive Lavage.…”