Etiology and variants of the course of calculous pancreatitis. Chronic calculous pancreatitis: treatment, diet, surgery. Features of the course and symptoms of the disease

Calculous pancreatitis is a disease of the pancreas in which calcium salts accumulate in it. Such processes occur due to a change in the chemistry of the gland juice, stones are formed that close the exit from the organ. They are stones from a lime mixture. They are small size, porous. Such a disease most often occurs after 50. What causes the disease, what are the symptoms and how to treat?

The reasons

There is no specific reason why it develops calculous pancreatitis. The disease occurs due to a combination of such factors:

• excessive drinking;
• frequent use of antibiotics;
• ulcer in the duodenum;
• gallbladder disease;
• hepatitis B and hepatitis C;
• problems in the urinary tract.

Symptoms

Symptoms of such inflammation of the pancreas depend on the location of the stones and their size. If they lie in the head or the organ itself, it hurts from the top right in the abdomen because the motor function of the large intestine is impaired. If only the head is inflamed - pain under the ribs. When analyzing, it can be observed that the acidity gastric juice above normal, the level of amylase in the urine and blood increases.

If pancreatitis covers the entire pancreas, tests will show secretory insufficiency. At the same time, painful sensations are little palpable. A symptom of calculous pancreatitis is stool disorders, constipation often occurs. The consistency of feces is mushy, may have residues undigested food. Chronic calculous pancreatitis may be accompanied by symptoms such as nausea and vomiting, as well as weight loss and excessive sweating.

Treatment

With calculous pancreatitis, self-medication is prohibited. Proper Treatment only a doctor can prescribe, depending on the stage of the disease and its severity. In this case, the specialist takes into account whether there are symptoms that indicate intrasecretory and exocrine insufficiency. If they exist, they need to be replaced. Treatment consists in prescribing drugs: insulin, pancreatin or others. enzyme preparations. During remission of chronic calculous pancreatitis, a spa treatment may be recommended.

During treatment, the doctor will definitely prescribe a diet, in last resort – surgical intervention.

In chronic pancreatitis, the use of traditional medicine must be agreed with the attending physician. It is forbidden to use them in the acute stage. They can only be used in mild form disease that is in remission.

Grandma's recipes for the treatment of calculous pancreatitis:

• Aspen bark. Decoction: 1 tablespoon up to 4 times a day. Powder: half a gram per day for 3 days before lunch.
• Dandelions. Grind a plant without flowers with roots, you should get a tablespoon. Pour in water and let stand for a day. Take 4 times a day, 50 ml.
• Blueberries and bean pods. The leaves of the plant must be crushed together with the bean pods. Pour a tablespoon into boiling water and boil for 5 minutes. Drink three times a day up to 2 tbsp. l.
• Oats. Twist the grains of the plant with a meat grinder. You should get a glass of gruel. Pour it with a liter of water and cook over low heat for 10 minutes. Consume up to 100 ml before meals.
• Wormwood. A pinch of powder is taken orally a quarter of an hour before meals twice a day. You can use infusion. For this, 1 tsp. powder is poured with a glass of boiled water. The liquid must be drunk during the day before meals.
• Potato juice. You need to drink up to 200 ml of juice, and after 5 minutes - kefir (200 g). This mixture should be taken 2 hours before meals for two weeks.
• Oat flour. 100 g boil. It will take 60 min. Later, add a quarter of a spoon of salt, 4 tsp. cherry syrup, 4 tsp. nuts (walnuts chopped). Bring everything to a homogeneous mixture. Then divide into 3 equal parts. Eat throughout the day before meals.

Calculous pancreatitis is a type chronic inflammation pancreas, in which calculi (stones) are formed in the duct. Chronic pancreatitis is often combined with cholelithiasis and requires radical treatment. Enzymes (trypsin, chymotrypsin, lipase, protease) and hormones (glucagon, insulin) are synthesized in the pancreas, which are involved in metabolic processes and digestion. Pancreatitis leads to a violation of their production. At acute inflammation it increases, and in chronic - decreases.

Main reasons

The main reasons for the development of this pathology are:

• Cholelithiasis. The gallbladder is initially affected. Against this background, the pressure in the ducts increases, which affects the state of the pancreas.
• Regular consumption of alcoholic beverages. Ethanol and its decay products have a toxic effect on the parenchyma of the organ.
• Reflux of bile into the pancreatic ducts.

The predisposing factors are:

• elevated levels of triglycerides in the blood;
• obstruction of the sphincter of Oddi;
• cicatricial tissue changes in the region of the duodenal papilla;
• autoimmune disorders;
• smoking;
• cystic fibrosis (damage to the glands of external secretion);
• increased levels of calcium in the blood;
• taking drugs that violate cholesterol metabolism (cephalosporins, somatostatin analogues, estrogens, fibrates);
• obesity;
• bowel disease;
• surgical interventions;
• excess in the menu of spicy and fatty foods;
• binge eating;
• eating 1-2 times a day at large intervals;
• change in the chemical composition of bile.

Symptoms

The signs of the disease are:

1. Pain. Localized on the left in the hypochondrium or upper abdomen. Less often it is shingles. It can proceed according to the type of biliary colic. Irradiates to the left chest and back. Accompanied by signs of a violation of the process of digestion of food. It increases with errors in nutrition and after drinking alcohol. Most often dull and aching, but can be stabbing and cutting.
2. Nausea.
3. Vomit. It happens repeatedly. During vomiting, bile may be secreted.
4. Heartburn.
5. Bitter burp.
6. Bloating due to increased formation of gases against the background of a violation of the synthesis of enzymes.
7. alternation liquid stool with constipation. In chronic pancreatitis, stool often contains remnants undigested food and a lot of fat, from which it is difficult to wash off and has a shine. With the development of inflammation against the background of cholelithiasis and stagnation of bile with the development of jaundice, feces may become discolored.
8. Decreased appetite.
9. Icteric skin tone.
10. Dryness of the skin.
11. Red-bluish spots in the abdomen and chest.
12. Pain in the upper part of the abdomen.

Sometimes with pancreatitis there is an increase in the liver and spleen.

Chronic and acute pancreatitis. Pancreatitis and calculous cholecystitis are safe treatments.

Elena Malysheva. Symptoms and treatment chronic pancreatitis

Diagnostics

If there are complaints, consultation with a gastroenterologist and a comprehensive examination of the digestive tract organs are required. To diagnose pancreatitis, you will need:

• Ultrasound of the abdominal organs;
• CT scan;
• endoscopic ultrasonography (study using ultrasonic waves using an endoscope and a sensor);
• retrograde cholangiopancreatography (contrast study);
• general and biochemical analyzes blood;
• analysis of urine and feces;
• functional tests;
• scintigraphy (study using radioactive isotopes);
• questioning the patient;
• palpation of the abdomen;
• percussion (tapping of various parts of the body);
• auscultation of the heart and lungs;
• measurement of pressure, pulse and respiratory rate.

With this form of pancreatitis, the following changes in laboratory parameters are possible:

• increased activity of elastase and trypsin in the blood;
• increase in the concentration of bilirubin in the blood;
• slight increase in ESR;
• leukocytosis;
• high blood cholesterol;
• an increase in alkaline phosphatase.

Ultrasound and tomography can detect calcareous deposits (stones) in the lumen of the pancreas, ducts and gallbladder. To exclude the pathology of the stomach, FEGDS can be performed (examination using a probe with a camera).

Differential diagnosis is carried out with cholecystitis, gastritis, peptic ulcer, tumors, Crohn's disease and ulcerative colitis.

Treatment of calculous pancreatitis

The main method of treating pancreatitis of this form is surgical. The treatment regimen is determined by the doctor. Most often, hospitalization is required.

Medical therapy

In the treatment of pancreatitis are used:

• antispasmodics (No-shpa, Drotaverin, Duspatalin);
• analgesics;
• NSAIDs;
• antibiotics (prescribed to prevent infectious complications);
• choleretic;
• detoxifying agents.

In acute calculous inflammation of the pancreas, when the production of enzymes is increased, protease inhibitors may be prescribed. Often drugs are used to lower blood sugar levels.

Cholagogues for pancreatitis with stones can only be prescribed with a functioning gallbladder. They are contraindicated in pronounced violation functions of the pancreas. Choleretic include: Urdoksa, Ursosan and Ursofalk.

Enzymes (Mikrazim, Pangrom, Creon) cannot be used in the acute stage of the disease. These drugs are prescribed only for enzyme deficiency on the background of chronic pancreatitis.

Enzymes are taken with meals in the absence of pain.

Physiotherapy

Physiotherapy can be done for pancreatitis. The most effective: diathermy, paraffin treatment and UHF therapy. Physiotherapy is indicated after surgery.

Diet

During the period of exacerbation, you need to refrain from eating. Health food allows drinking non-carbonated water, jelly, rice water, herbal infusions and rosehip decoction. A few days later, a treatment table No. 5 is assigned. The goals of such a diet are to spare the pancreas and improve the flow of bile.

From the menu you need to remove foods that contain cholesterol, purines, essential oils and oxalic acid.

The diet is enriched with products containing vitamins, lipotropic substances, pectin and alimentary fiber. Dishes are baked, boiled or stewed. You can not eat fried, smoked, pickled and salty foods.

Meal regimen - 5-6 times a day in small portions with the same intervals. Before use, products are recommended to grind or wipe. Dishes for pancreatitis should be at room temperature.

With inflammation and stones in the pancreas, the following are allowed for use:

• yesterday's dried bread;
• dry biscuit;
• lean fish;
• seafood;
• lean meat (poultry, rabbit);
• dairy and vegetable soups without seasonings;
• dairy products, including low-fat cottage cheese;
• mild cheese;
• vegetable and butter oils;
• cereals;
• protein omelet;
• vegetables;
• dried fruits;
• some nuts;
• baked apples;
• vegetable juices;
• green tea;
• greens (parsley, dill).

Prohibited for use in pancreatitis:

• confectionery and pastry products;
• carbonated and alcoholic drinks;
• sausages;
• canned food;
• marinades;
• pickles;
• fatty foods;
• egg yolk;
• mayonnaise;
• crisps;
• salo;
• rich soups;
• mushrooms;
• sour cream;
• fermented baked milk;
• fatty cottage cheese;
• cream;
• offal;
• sorrel;
• spinach;
• radish;
• green onions;
• radish;
• garlic;
• chocolate;
• strong coffee;
• sauces;
• ice cream;
• cold drinks;
• pasta.

Diet number 5 according to Pevzner

Diet for pancreatitis

What can you eat with pancreatitis?

Diets for pancreatitis should be followed for about a month.

Operation

With obstruction (blockage) of the pancreatic duct, surgical intervention is indicated. Operations are endoscopic and open. The former are the most gentle and less traumatic. If necessary, anesthesia is required. The following interventions may be carried out:

• resection of the pancreas;
• duct drainage;
• papillosphincterotomy;
• formation of an anastomosis;
• removal of non-viable tissues;
• cholecystectomy ( complete removal gallbladder).

Surgery is the most effective treatment for the disease.

Folk remedies

In addition to surgery and drug therapy are folk remedies in the form of herbal infusions, decoctions and tinctures.

With pancreatitis with stones are effective:

• fresh potato juice;
• decoction of oat grains;
• a decoction based on blueberry leaves and bean pods;
• rosehip decoction.

With inflammation of the pancreas, an infusion of wormwood is useful, it should be consumed before meals.

You can prepare an infusion of wormwood. This will require 1 tsp. dried plant and 1 cup boiling water. This infusion should be drunk during the day, divided into equal portions. Use it before meals.

Complications

Most frequent complications pancreatitis of this type are:

• colic;
• joining the infection;
• the occurrence of abscesses;
• pancreatic necrosis;
• peritonitis;
• shock state;
• jaundice;
• accumulation of fluid in the parenchyma of an organ or in the abdominal cavity;
• multiple organ failure;
• portal hypertension;
• internal bleeding;
• perforation of the duct or wall of the gland with a stone;
• cellulitis cellulose;
• encephalopathy;
• syndrome of disseminated intravascular coagulation.

In the absence of proper assistance, a fatal outcome is possible. Complications of pancreatitis most often occur when the diet is not followed, the inability to exclude alcohol, refusal of surgery and late visits to the doctor.

Forecast

The following factors influence the prognosis for this pathology:

• correctness and timeliness of treatment;
• the presence of concomitant diseases;
• the age of the patients.

With chronic pancreatitis and the absence of therapy, dystrophic changes progress. Calcification and sclerosis of the gland are possible. If all the recommendations of the gastroenterologist are followed, the prognosis is most often favorable.

Peculiarities

Pancreatitis with stones of various etiologies has its own characteristics.

The most commonly diagnosed inflammation of the gland in combination with cholelithiasis.

Calculous pancreatitis and cholecystitis

Women are more likely to suffer from calculous cholecystitis and pancreatitis. Stones are cholesterol (detected in 80% of cases) and pigmented.

When pancreatitis is combined with cholecystitis, biliary colic often occurs. This is an acute pain syndrome. The attack most often occurs at night. The pain is aggravated when inhaling and in the position on the left side. Concerned about repeated vomiting and general malaise. This condition requires urgent care.

The human body is a reasonable and fairly balanced mechanism.

Among all infectious diseases known to science, infectious mononucleosis has a special place...

about the disease, which official medicine calls "angina pectoris", the world has known for a long time.

Mumps (scientific name - parotitis) is called an infectious disease ...

hepatic colic is typical manifestation cholelithiasis.

Cerebral edema - these are the consequences excessive loads organism.

There are no people in the world who have never had ARVI (acute respiratory viral diseases) ...

healthy body a person is able to assimilate so many salts obtained from water and food ...

Bursitis knee joint is a widespread disease among athletes...

Calculous chronic pancreatitis

Chronic calculous pancreatitis: treatment, diet, surgery

One type of pancreatitis is calculous pancreatitis. Let's try to figure out what are the causes of this disease, the symptoms of the disease. How is the treatment carried out? What is the forecast? Is the diet effective? Let's find answers to these and other questions.

What is the disease?

Calculous pancreatitis is inflammatory disease pancreas, flowing with deposits of calcium salts in the tissues of the organ. This happens due to pathologies and violations of the chemical composition of pancreatic juice. As a result, stones are formed in the area of ​​​​the excretory duct of the organ.

Most often, these stones consist of phosphate and carbonic lime. Usually they are small in size, they look like sand of a gray-white hue, relatively low density and porous structure.

Most often, chronic calculous pancreatitis occurs in the female half of humanity, over the age of 50, and is popularly called pancreatic stones. It is extremely rare and chronic.

Causes of the disease

Usually, calculous pancreatitis occurs due to the following reasons:

• frequent and uncontrolled use of antibiotics;
• alcohol abuse;
• cholecystitis;
• hepatitis B and C;
• -cholelithiasis;
• duodenal ulcer.

Symptoms of the disease

Symptoms of the disease directly depend on the form of the course of the disease (acute or chronic) and on the location of the stones in the pancreas itself:

1) Pain of a different nature:

• In the case when the stones have arisen and settled in the body or head of the pancreas, the pain is localized under the pit of the stomach or in the middle part of the abdomen.
• In the case when the stones are located in the body of the pancreas, the pain syndrome is felt in the right side of the abdomen.
• When the stones are located in the tail of the organ, pain is felt on the left in the hypochondrium.
• In the case when the stones hit the entire gland, the patient is tormented by girdle pain.

2) Change in the nature of the chair. Usually the patient suffers from constipation. The stool may be mushy. There may also be undigested food in the stool.

3) Frequent nausea and in some cases vomiting.

4) Increased sweating.

5) Slimming.

6) Increased heart rate.

If the stones are located in the entire pancreas, begins to develop diabetes. In this case, the pain is mild or absent.

Diagnosis of the disease

To make an accurate diagnosis, the doctor uses the following diagnostic methods:

• Ultrasound procedure. Allows you to determine the width of the pancreatic duct and the presence or absence of stones in it.
• Laboratory tests. In the analysis of blood and urine, an increase in amylase occurs.
• X-ray examination. Allows you to view one or more small stones.
• Endoscopic retrograde pancreatography. This method is used as an additional method when the above methods did not give effective results.

Treatment of the disease

Treatment of calculous pancreatitis must be prescribed by a doctor, since this is a very serious and dangerous disease. Methods of treatment depend directly on the severity of the course of the disease.

1) The mode of sanatorium-resort.

2) Complex of medical procedures:

• - internal reception mineral waters (drinking treatment, gastric lavage, rectal procedures, drainage of the biliary tract and others).
• - external intake of mineral waters (reception of mineral baths).
• - mud treatment.
• - physiotherapy and climate therapy.

3) Physiotherapy:

• - UHF therapy;
• - diathermy;
• - paraffin;
• - Sollux and others.

4) Medical nutrition.

Most often, this disease is treated with the help of a surgical method. If there are symptoms of internal and exocrine insufficiency, the patient is prescribed insulin injections. As mentioned above, the most effective method that is used to treat calculous pancreatitis is the surgical method. The purpose of the surgical operation is to create good conditions for the outflow of juice in the gastrointestinal tract from the pancreas itself.

Depending on how affected the gland with ducts, the following types of surgical interventions are performed:

• Subtotal pancreatectomy (resection of the pancreas). This operation is prescribed when there is a large lesion of the pancreas and most of the cells of the organ die.
• Transduodenal papillosphincterotomy, in which the pancreatic duct is drained.
• Resection of the distal part of the pancreas and sewing it into the colon.
• Anastomosis between the loop of the small intestine and the pancreatic duct.

Methods and means of traditional medicine

With the permission of the attending physician, alternative methods can be used to treat calculous pancreatitis in the stage of stable remission.

So, commonly used the following means alternative medicine:

• walnut tincture";
• juice from fresh potatoes and carrots;
• tincture of chamomile flowers, St. John's wort, wormwood, mint leaves and yarrow;
• decoction or powder of aspen bark;
• a decoction of the roots and leaves of dandelions;
• a decoction of bean pods and blueberry leaves;
• decoction of oatmeal;
• bitter wormwood tincture;
• powdered stems of bittersweet nightshade. Take 15 minutes before meals three times a day. In the case of the appearance of sweet sensations, we can conclude that there is a strong inflammation of the pancreas. If such a sensation occurs after 15 minutes, then the disease proceeds in a weak form.
• a mixture of calamus roots, dandelion, nettle, mint leaves, thyme and hop cones, honey or jam;
• decoction of anise fruits, corn silk, herbs of celandine, tricolor violet root and dandelion, herbs of bird mountaineer.

Diet

In calculous pancreatitis, important point is proper nutrition and dieting. From the diet it is necessary to exclude all fried and sweet. Food should be fractional, small portions. Food should be of medium temperature (neither too hot nor too cold).

Let's get acquainted with the products allowed for this ailment:

• lean poultry, fish and meat.
• low-fat cottage cheese. It can be used in fresh Or make casseroles out of it.

Consumed dishes are preferably steamed or boiled. During periods of exacerbation of the disease, it is recommended to bake vegetables or fruits.

• herbal teas;
• rosehip decoction;
• various kissels.

Here sample menu diet for this disease

• cookies and dry bread;
• grated soups cooked in low-fat broth;
• low-fat dairy products;
• casseroles;
• omelets. For cooking, use only protein.

An excellent breakfast can be buckwheat, semolina or oatmeal. But porridge should be consumed only in grated form. Fruits are allowed for this pathology only non-acidic varieties.

Disease prognosis

In calculous pancreatitis, specialists usually leave poor prognosis, since this ailment can often be reborn into malignant tumor. Also, with this disease, the patient's working capacity usually decreases, for this reason, in some cases, a disability group is assigned.

Timely diagnosis, proper nutrition, rejection of bad habits will avoid the development of many dangerous pathologies and complications.

1pankreatit.ru

Chronic calculous pancreatitis - symptoms, treatment, surgery, diet

The cause of the development of calculous pancreatitis is a violation of the chemical composition of pancreatic juice caused by inflammatory processes in it or stagnation. As a result of these processes, stones are formed in the excretory duct of the pancreas.

As a rule, they consist of lime carbonate, have a porous structure and can be presented in the form of sand or small stones that clog the duct, which invariably entails its expansion, as well as a violation of the integrity of the tissues. As a result, inflammatory processes are formed in the pancreatic parenchyma, leading to the appearance of abscesses and ulcerations.

The manifestation of the disease begins with an attack acute pain similar to an attack of gallstone disease. Distinctive features calculous pancreatitis is the absence of jaundice and diarrhea.

Put correct diagnosis can be done using X-ray, endoscopic and ultrasound examinations. As a rule, in the picture you can clearly see one or more stones that look like champagne splashes. It is important not to confuse stones with lymph nodes. It is possible to confirm the diagnosis of chronic calculous pancreatitis or, on the contrary, to refute it, using an endoscopic examination.

The severity of the patient's condition and the tactics of his treatment in chronic calculous pancreatitis depends on the location of the stones in the pancreas. So, for example, when they are located directly in the body of the gland or in its head, an acute pain syndrome, pain in the large intestine and its dyskinesia are observed. At laboratory research blood, an increase in amylase is observed, as well as an increase in the acidity of gastric juice.

In the event that stones are found in the entire pancreas, diabetes mellitus develops. In this case, the pain syndrome can be expressed weakly or absent altogether.

It should be noted that calculous pancreatitis is relatively rare and in most cases is chronic. The disease has an unfavorable prognosis, the main cause of which is malignant transformation of pancreatic tissues.

The main method of treatment is based on surgical intervention. In diabetes mellitus caused by calculous pancreatitis, replacement therapy is indicated.

Symptoms of a disease such as calculous pancreatitis depend primarily on the location of the stones. If they are located on the head or in the body of the pancreas, then the main symptom will be a feeling of pain in the pit of the stomach or in the right upper area belly. In the case when the stones are located near the tail of the pancreas, pain occur in the left hypochondrium. In all other cases, the pain will be girdle in nature.

The symptoms of calculous pancreatitis include not only a feeling of pain, but also changes in the stool. Its consistency becomes mushy with inclusions of particles of undigested food and a foamy substance. The stool has an unpleasant characteristic odor.

Surgery for acute calculous pancreatitis

Acute calculous pancreatitis is one of the rather serious dangerous diseases, the treatment of which is mainly carried out surgically. In cases of detection of intrasecretory external insufficiency, insulin injections are indicated to the patient.

The prognosis for such a disease is most often unfavorable, i.e., in most cases, the process of malignant degeneration starts. In other forms of the disease, the frequency of this process is several times lower.

After the operation, patients with acute calculous pancreatitis should undergo rehabilitation in one of the special sanatoriums, on the basis of which the necessary procedures and a sparing diet will be organized.

Diet for calculous pancreatitis

Like all other forms of this disease, this one also requires patients to follow a certain diet. The menu of patients should not contain anything fried and sweet. All meals should be served warm (hot or cold food will only aggravate the condition of the pancreas). Meals should be carried out according to the rule "often, but little", the ideal option would be five to six meals a day.

The diet menu for chronic calculous pancreatitis can be represented by dry bread and biscuits, grated soups prepared on the basis of low-fat meat broth, lean fish or boiled poultry meat. The diet may contain low-fat dairy products, casseroles, protein omelettes.

The ideal option morning meals can be porridge made from buckwheat, oatmeal or semolina. At the same time, it is worth noting that even porridge should be served on the table in a grated form. As for vegetables, they should be consumed after pre-cooking. Fruits can also be included in the menu, but they must be non-acidic.

zhkt.guru

Causes and treatment of calculous pancreatitis

Calculous pancreatitis is a disease of the pancreas in which calcium salts accumulate in it. Such processes occur due to a change in the chemistry of the gland juice, stones are formed that close the exit from the organ. They are stones from a lime mixture. They are small and porous. Such a disease most often occurs after 50. What causes the disease, what are the symptoms and how to treat?

The reasons

There is no specific reason why calculous pancreatitis develops. The disease occurs due to a combination of such factors:

• excessive drinking;
• frequent use of antibiotics;
• ulcer in the duodenum;
• gallbladder disease;
• hepatitis B and hepatitis C;
• problems in the urinary tract.

Symptoms

Symptoms of such inflammation of the pancreas depend on the location of the stones and their size. If they lie in the head or the organ itself, it hurts from the top right in the abdomen because the motor function of the large intestine is impaired. If only the head is inflamed - pain under the ribs. When conducting tests, it can be observed that the acidity of gastric juice is above normal, the level of amylase in the urine and blood increases.

If pancreatitis covers the entire pancreas, tests will show secretory insufficiency. At the same time, painful sensations are little palpable. A symptom of calculous pancreatitis is stool disorders, constipation often occurs. The consistency of feces is mushy, may have the remains of undigested food. Chronic calculous pancreatitis may be accompanied by symptoms such as nausea and vomiting, as well as weight loss and excessive sweating.

Treatment

With calculous pancreatitis, self-medication is prohibited. Only a doctor can prescribe the correct treatment, depending on the stage of the disease and its severity. In this case, the specialist takes into account whether there are symptoms that indicate intrasecretory and exocrine insufficiency. If they exist, they need to be replaced. Treatment consists in prescribing drugs: insulin, pancreatin or other enzyme preparations. During remission of chronic calculous pancreatitis, a spa treatment may be recommended.

During treatment, the doctor will definitely prescribe a diet, in extreme cases - surgical intervention.

Folk remedies

In chronic pancreatitis, the use of traditional medicine must be agreed with the attending physician. It is forbidden to use them in the acute stage. They can only be used in a mild form of the disease that is in remission.

Grandma's recipes for the treatment of calculous pancreatitis:

• Aspen bark. Decoction: 1 tablespoon up to 4 times a day. Powder: half a gram per day for 3 days before lunch.
• Dandelions. Grind a plant without flowers with roots, you should get a tablespoon. Pour in water and let stand for a day. Take 4 times a day, 50 ml.
• Blueberries and bean pods. The leaves of the plant must be crushed together with the bean pods. Pour a tablespoon into boiling water and boil for 5 minutes. Drink three times a day up to 2 tbsp. l.
• Oats. Twist the grains of the plant with a meat grinder. You should get a glass of gruel. Pour it with a liter of water and cook over low heat for 10 minutes. Consume up to 100 ml before meals.
• Wormwood. A pinch of powder is taken orally a quarter of an hour before meals twice a day. You can use infusion. For this, 1 tsp. powder is poured with a glass of boiled water. The liquid must be drunk during the day before meals.
• Potato juice. You need to drink up to 200 ml of juice, and after 5 minutes - kefir (200 g). This mixture should be taken 2 hours before meals for two weeks.
• Oat flour. 100 g boil. It will take 60 min. Later, add a quarter of a spoon of salt, 4 tsp. cherry syrup, 4 tsp. nuts (walnuts chopped). Bring everything to a homogeneous mixture. Then divide into 3 equal parts. Eat throughout the day before meals.

Surgical intervention

With this type of chronic pancreatitis, surgery is considered the most effective treatment. With its help, they help to ensure the outflow of enzymes from the pancreas. There are several types of this procedure:

• impose an anastomosis;
• make a resection of the pancreas and sew into the small intestine;
• conduct transudenal papillosphincterotomy and drain the pancreatic ducts;
• cut out part of the gland.

diet therapy

In any case, with chronic pancreatitis, it is necessary to eat diet food. All hazards, for example, fried, smoked, salted, products with a chemical composition, must be completely excluded. You need to eat many times in small portions. Food should be slightly warmer than room temperature, cold and hot are not allowed. Low-fat varieties of fish and meat, cottage cheese, baked vegetables are allowed. Steam, bake, or boil.

Forecast

Often chronic pancreatitis develops into a malignant disease. It limits the patient's ability to work, so group 2 disability is not uncommon.

pishchevarenie.ru

Etiology and course of calculous pancreatitis

A disease such as calculous pancreatitis can bring a lot of problems to a person's life. It is characterized by inflammation of the pancreas due to the formation of deposits of calcium salts in it. They condense, forming porous stones in the ducts of the organ, and cause significant discomfort.

Reasons for development

Any problems with the digestive tract do not arise spontaneously. They are provoked by several factors at once, which have a gradual destructive effect on the body. The causes of the calculous form of pancreatitis can be:

• liver pathology, in particular hepatitis B and C;
• gallbladder disease;
• stomach and duodenal ulcer;
• pathology of blood vessels and connective tissue;
• malnutrition;
• bad habits;
• taking medications;
• ecology.

A person's lifestyle plays a special role. Polluted city air, alcohol abuse, erratic diet - this is a serious burden for the pancreas. These same factors worsen the condition of adjacent organs. Wrong or untimely treatment problems of the gastrointestinal tract, long-term use of antibiotics provoke a violation of metabolic processes in tissues. As a result of all this, calculi are formed in the pancreatic ducts, accompanied by inflammation.

Symptoms and manifestations

The manifestations of this form of the disease are somewhat different from the usual course of inflammation of the pancreas.

Often, the symptoms of calculous pancreatitis are less pronounced and largely depend on the localization of stones in this organ.

Most often, patients complain about:

• pain in the hypochondrium and middle part of the abdomen;
• nausea, sometimes vomiting;

• stool disorders, constipation;
• change in the consistency of feces to frothy with an unpleasant odor, containing inclusions of undigested food;
• increased acidity of gastric juice;
• increased sweating;
• weight loss.

Pain is directly related to the location of the stones. The inflamed head responds with pain in the hypochondrium. If the stomach hurts on the right, the body of the pancreas is affected, on the left, its tail. At complete defeat gland discomfort becomes girdle.

The inflamed organ puts pressure on the intestines, which provokes discomfort in the central part of the abdomen and stool disorders. Calculous pancreatitis also affects the secretion of gastric enzymes. It is this phenomenon that explains the incomplete digestion of food and the presence of its particles in the feces.

Forms of the disease

The severity of symptoms and further treatment to a certain extent depend on the form of the disease. There are acute and chronic calculous pancreatitis.

The acute form of the disease is characterized by an intense manifestation of symptoms. The patient feels severe pain, which may be associated with the displacement of stones, nausea, up to vomiting. Body temperature may rise and fever may occur. AT this case immediate medical intervention is required.

The chronic form of calculous pancreatitis is characterized by a weak manifestation of symptoms. During periods of remission, they are almost completely absent. Deposits of calcium salts in this case have small volumes, therefore they are not so dangerous for humans. However, they continue to accumulate unless appropriate treatment and prevention measures are taken.

Exacerbation of chronic pancreatitis occurs when using junk food, certain drugs, or alcohol. Stress also contributes its share, so experiences should be minimized - they worsen the condition of the entire gastrointestinal tract. In the presence of other pathologies of the digestive or hepatobiliary systems, the development of such diseases entails the resumption of inflammation of the pancreas.

Diagnostics and prognosis

Diagnosis of calculous pancreatitis is carried out in a complex manner. First of all, you need to consult a gastroenterologist. The doctor conducts an initial examination and interview of the patient to find out to what extent the disease manifests itself. To clarify some points, you may also need to consult an endocrinologist.

To determine the current state of the pancreas, blood and urine tests, a coprogram, and ultrasound are prescribed. You may also need diagnostic methods such as angiography, retrograde cholecystopancreatography, CT. Based on the results obtained, a necessary treatment.

The prognosis of recovery depends on the degree and form of the pathology, as well as what treatment was prescribed.

A full examination is carried out if the patient's condition allows. In the event of an attack of pancreatitis, an ambulance call and emergency assistance are required. In general, any damage to the pancreas is a serious danger to humans. AT rare cases possible development oncological diseases.

Treatment Methods

Treatment of calculous pancreatitis consists of several directions. With a moderate course of the disease are used:

• Medicines. Medicines are used on a limited basis. Their goal is to eliminate symptoms (pain, nausea), normalize stool and digestive process, stimulation of the breakdown of deposits and the removal of inflammation.

• Folk remedies. Auxiliary treatment to the main therapy. The following have worked well: chamomile decoction, St. John's wort tincture, carrot juice, yarrow.
• Physiotherapy. It is aimed at restoring the functioning of organs, treating concomitant diseases and accelerating tissue regeneration.
• Sanatorium-resort procedures. Doctor prescribes baths, reception mineral water suitable composition, establishes a valid menu.

If the patient's condition is severe, the stones interfere normal activities organ or provoke necrotic processes, urgent surgical intervention is necessary. The operation for calculous pancreatitis is aimed at restoring the outflow of gland secretion. To do this, drainage of the tubules is carried out with the removal of deposits of calcium salts. If the organ has begun to collapse, an operation is performed to remove dead or severely damaged areas of the gland.

Preventive actions

Treatment must be supplemented with measures to prevent the occurrence of recurrent attacks. This is especially true in chronic pancreatitis.

The list of preventive measures includes:

• reducing alcohol consumption;
• minimization of drug effects on the body;
• balanced balanced diet;
• to give up smoking;
• avoidance stressful situations;
• complete rest.

The main emphasis, both in treatment and prevention, is on nutrition.

With an exacerbation of the disease, food is taken in processed form: pureed boiled vegetables, chicken soufflé, hateful soups. Less salt should be used, and fatty, smoked, fried and sweet should be completely abandoned.

With pancreatitis and cholecystitis menu

If congestion occurs in the pancreas or inflammatory processes begin, they disrupt the chemical composition of its juice, which leads to the formation of stones, small stones or sand, consisting of carbonic lime, in the excretory duct. They clog the duct and lead to its inflammation in a short time. AT medical practice this pathology, which occurs with virtually no symptoms, is called chronic calculous pancreatitis. Vivid signs of the disease appear only with its exacerbation, which develops immediately after a person with this pathology has abused alcoholic beverages, poor-quality food, or taken certain groups of drugs uncontrollably.

Features of the course and symptoms of the disease

As already mentioned, pancreatitis of the calculous type develops as a result of a pathological change in the chemical composition of the juice contained in the pancreas. This main cause of this disease is associated with the appearance of stagnant or inflammatory processes in this digestive organ, provoking the development of calcareous stones in it - stones that completely close the duct. This reason is the main one in the development of pathology, but there are several risk factors that accelerate the pathological process:

• the presence in the patient's history of pathologies of connective tissue or blood vessels;
• prolonged uncontrolled use of antibiotics;
• alcohol abuse;
• directly provoke this disease liver pathologies such as cholelithiasis, hepatitis and cirrhosis may also occur.

The very first manifestation of calculous pancreatitis is almost completely similar to the development of the last named liver diseases in humans - this is an attack of acute pain. But there is also a feature - this is the presence of diarrhea and at the same time the absence of jaundice.

Clinical manifestations of the disease

The clinic of calculous pancreatitis for the most part depends on the form in which the pathological process proceeds - acute or chronic. In addition, on symptomatic manifestations, namely the direct location of the pain, the location of the stones in the gland also has a great influence. In the case of the location of stones in the body of the pancreas, pain affects middle part abdomen, in the body of the gland - in the right, and when they are localized in its tail, severe pain is felt in the left hypochondrium. In the same case, when the entire pancreas is affected by stones, the pain is girdle.

The patient also has other symptoms, according to which experienced specialist may suspect the development of calculous pancreatitis:

• A person with this disease suffers from constipation, but at the same time, the feces during the act of defecation have a mushy structure, and they contain the remains of undigested food. The patient's stool is always with an unpleasant odor.
• Frequent bouts of nausea, sometimes turning into severe vomiting.
• Unexpected (for no particular reason) and large weight loss.
• The heart rate is greatly increased.
• Constant sweating.

In the case when the stones are located in the entire gland, a person begins to develop diabetes mellitus. In such a situation, painful sensations may not be present at all or may be so mild that the patient simply will not respond to them.

Experts strongly recommend that everyone who is at risk for the development of this pathology pay attention to warning signs. In the event that 2 or more symptoms appear, you should immediately consult a doctor and undergo the necessary diagnostic examination. This will help to identify a dangerous disease at the very beginning and increase the chances of recovery.

Diagnosis and therapy of the disease

In order to find out the current clinical condition of the pancreas and prescribe adequate treatment(conservative or operative), the specialist gastroenterologist needs the results of a special diagnostic study.

To obtain the necessary data for patients with suspected calculous pancreatitis, the following research methods are prescribed:

• Laboratory tests of blood and urine may show elevated levels of amylase (a special digestive enzyme), which confirms damage to the pancreas.
• X-ray. This research method allows you to see if there are any in the duct or body digestive organ stones, and how many are available. Only an experienced diagnostician will be able to distinguish true calculi from a calcified lymph node.
• Ultrasound helps to determine the width of the pancreatic duct, as well as the presence of stones in it.
• Endoscopic retrograde pancreatography is performed infrequently. This method of research is necessary only when it is difficult to make an accurate diagnosis.
• A complete examination of the patient can only be carried out in the remission phase, since with a relapse of the disease, the patient's condition deteriorates sharply, and he needs emergency medical care.

Main therapeutic measures

Treatment of calculous pancreatitis is carried out in several directions. If the course of this dangerous disease is moderate, the following methods are used:

• Medical therapy. Medicines with it are applied in the most limited manner. Their goal is to eliminate the main symptomatology, pain, nausea and vomiting, as well as withdrawal inflammatory process, normalization of the digestive process and stool. Physiotherapy. The use of this method is aimed at accelerating tissue regeneration, eliminating concomitant diseases and restoring the functioning of the affected organs.
• Auxiliary treatment with folk remedies. It is carried out only under the guidance of a specialist. It is categorically not recommended to resort to it on your own, since you can only aggravate the pathological situation.
• Sanatorium-and-spa treatment, in which patients are selected an acceptable menu and prescribed the intake of mineral water of the composition corresponding to their condition.

In the case when the condition of a sick person is quite severe, the calculi interfere with the normal activity of the digestive gland or begin to provoke the development of a necrotic process in it, an urgent operation is required.

Surgical treatment aims to restore the outflow of juice from the digestive organ. This is achieved by removing stones from the tubules of the digestive gland and then draining them.

The prognosis for calculous pancreatitis, left by specialists, is usually unfavorable, since this disease is often malignant. In addition, pathology significantly reduces a person's performance. It is with these factors that in most cases people with a history of this disease are assigned a disability group. Timely diagnosis, adequate treatment, rejection of bad habits and proper nutrition can help to avoid this.

The invention relates to medicine, namely to surgical gastroenterology, and can be used in the treatment of patients with chronic calculous pancreatitis.

Patients with chronic calculous pancreatitis undergo resection and drainage operations, the purpose of which is to eliminate hypertension of the main pancreatic (Wirsung) duct and, as a result, relieve pain. Drainage operations, during which decompression is achieved by the imposition of pancreatoenteroanastomosis, are organ-preserving in nature and are a common and pathogenetically substantiated method of treating chronic calculous pancreatitis (Shalimov A.A., Grubnik V.V., Horowitz D., Zaichuk A.I., Tkachenko A. .I. Chronic pancreatitis. - Kyiv: Health, 2000. - S. 166).

A known method of surgical treatment of chronic pancreatitis (patent SU 445414, publ. 05/28/1975) - excision of a quadrangular flap of the anterior wall of the pancreas up to 10 cm long, including the Wirsung duct with adjacent areas of the parenchyma, followed by the imposition of a longitudinal pancreatoenteroanastomosis. Moreover, between the afferent and outlet loops of the small intestine, then enteroanastomosis is performed with a plug on the afferent loop. The disadvantage of this method is the reflux of intestinal contents into the ductal system of the pancreas.

A method for internal drainage of the ductal system of the pancreas is proposed, in which 2-4 deep longitudinal incisions of the anterior wall of the gland are made to open the Wirsung duct, after which the formation of pancreatoenteroanastomosis is performed (Taylor R.H., Bagley F.H., Braasch J.W., Warren K.W. Ductal drainage or resection for chronic pancreatitis American Journal of Surgery 1981; 141(1): 28-33). The disadvantage of this method is excessive trauma when applying longitudinal incisions and inadequate drainage of the ductal system.

As a prototype, the above method was used by Propp A.R., Poluektov V.L. Their method of longitudinal pancreaticoenteroanastomosis (patent RU 2296517, publ. 04/10/2007), in which the pancreatic parenchyma is excised throughout the longitudinal incision at equal distances in the form of triangular fragments with bases on the longitudinal incision and vertices facing the upper and lower edges of the pancreas glands. However, this method is not without such disadvantages as the possibility of massive bleeding due to the intersection of vessels located along the anterior and lateral surfaces of the pancreas, and increased traumatization of the pancreatic parenchyma, leading to endo- and exocrine insufficiency.

All of the above methods are modifications of the longitudinal pancreatojejunostomy operation described by Puestow Ch., Gillesby W. (Retrograde surgical drainage of pancreas for chronic relapsing pancreatitis. A.M.A. Archives of Surgery. 1958; 52: 898-907) and improved by Partington P.F., Rochelle R.E.L. (Modified Puestow procedure for retrograde drainage of the pancreatic duct. Annals of Surgery. 1960; 152(6): 1037-1043). Given surgical intervention is the closest way to the declared one. The main steps of this operation are as follows. After the implementation of the median laparotomy, dissection of the gastrocolic ligament, revision of the pancreas, the pancreatoduodenal complex is mobilized, the Wirsung duct is punctured. Then proceed to the opening of the duct with a scalpel, after which the duct is taken on the holders, which stitch the entire thickness of the parenchyma of the dissected gland. A grooved probe is inserted into the Wirsung duct and further opening of the duct is made along it. Next, a Y-shaped anastomosis is applied, a long loop of the jejunum (30-40 cm), turned off according to Roux, is used. The crossed end of the jejunum mobilized according to Roux is stitched with a hardware or manual suture and then brought to the distal part of the pancreas to perform a directly longitudinal pancreatojejunoanastomosis, which is applied isoperistaltically. The disadvantage of this method in the treatment of patients with chronic parenchymal calculous pancreatitis is insufficient drainage of the ductal system of the pancreas due to limited removal of stones in the parenchyma of the gland.

The technical result of using the claimed method is to eliminate these deficiencies and the presence of advantages: 1) the possibility of crushing and removing stones both in the Wirsung duct and in the pancreatic parenchyma; 2) the possibility of crushing and removing stones in the distal part of the duct, then the line of dissection of the Wirsung duct in order to improve the outflow from the tail of the pancreas; 3) the possibility of crushing and removing stones in the proximal part of the Wirsung duct before passing the instrument at the mouth of the main pancreatic duct in order to improve the outflow from the ducts of the 1st order of the head of the pancreas; 4) the possibility of removing part of the upper and lower walls of the Wirsung duct in order to open the ducts of the I-II order. The above advantages of the claimed method make it possible to reduce indications for performing resection operations, including Beger's operation.

The task to be solved by the claimed invention is to develop an effective method for the surgical treatment of chronic calculous pancreatitis, which will eliminate the pronounced pain syndrome in most patients, which, in turn, will significantly reduce material costs for further treatment and rehabilitation of such patients.

This task is achieved due to: 1) the practical implementation of the principle of double drainage, which consists in the possibility of outflow of pancreatic juice both through the longitudinal panreatojejunoanastomosis and through the restored mouth of the Wirsung duct, 2) opening the lumen of the Wirsung duct at the border of the head and body of the pancreas, allowing more long time do not obliterate the pancreatojejunostomy.

The method of surgical treatment of chronic calculous pancreatitis, confirmed by ultrasound and computed tomography, is performed as follows. An upper median laparotomy is performed. By dividing the gastrocolic ligament, access is made to the lesser omentum. The duodenum is mobilized according to Kocher and the lower edge of the body of the pancreas is mobilized. Perform intraoperative ultrasound of the pancreas. Under ultrasound control, a puncture and opening of the Wirsung duct is performed, the main pancreatic duct is dissected up to 8-10 cm long. An ultrasonic dissector crushes and removes stones in the duct and its walls, after which part of the upper and lower walls of the Wirsung duct are removed with the opening of ducts I-II- order. An ultrasonic dissector crushes and removes calculi in the distal part of the pancreas beyond the duct dissection line, in the lumen of the proximal part of the Wirsung duct before the instrument passes through the mouth of the main pancreatic duct. At the border of the head and body of the gland, the opened Wirsung duct is expanded to 1.5-1.8 cm, similar to Frey's operation. A loop of the jejunum is isolated 15-20 cm from the ligament of Treitz, mobilized and transected. Impose a longitudinal pancreatojejunoanastomosis side-to-side. The parenchyma and the pancreatic capsule and all layers of the jejunum wall are captured by the first row with a continuous suture, the capsule of the gland and the sero-muscular membrane of the jejunum are captured by the second row. A window in the transverse mesentery is sutured with several sutures. colon. An inter-intestinal anastomosis is applied according to Roux distal to the pancreatojejunoanastomosis by 40-45 cm.

Clinical example. Patient P., aged 56, was admitted with a diagnosis of Chronic pancreatitis. Considers himself ill for 4 years. Repeatedly treated for exacerbations of chronic pancreatitis. Relapses of the disease up to 3 times a year. Over the past year, she notes an increase in exacerbations, an increase in pain. Examination (ultrasound, computed tomography) revealed chronic calculous ductal and parenchymal pancreatitis. 5 days after admission, the patient underwent an operation - longitudinal pancreatojejunostomy on the turned off loop of the jejunum according to Roux. Upper median laparotomy. By dividing the gastrocolic ligament, access was made to the lesser omentum. Mobilization of the duodenum according to Kocher. Mobilization of the lower edge of the body of the pancreas. Calculi were determined by palpation in the pancreatic parenchyma, after which intraoperative ultrasound of the pancreas was performed. Under ultrasound control, a puncture and opening of the Wirsung duct was performed, the main pancreatic duct was cut up to 8 cm long. An ultrasonic dissector performed fragmentation and removal of stones in the duct and its walls, after which part of the upper and lower walls of the Wirsung duct was removed with the opening of the lumen of the ducts I-II- order. An ultrasonic dissector performed fragmentation and removal of calculi in the distal part of the pancreas beyond the duct dissection line, in the lumen of the proximal part of the Wirsung duct before the instrument passed through the mouth of the main pancreatic duct. On the border of the head and body of the gland, the opened Wirsung duct was expanded to 1.5-1.8 cm, similar to Frey's operation. A loop of the jejunum was isolated 15-20 cm from the ligament of Treitz, it was mobilized and transected. A side-to-side longitudinal pancreatojejunoanastomosis was applied behind the colon. A window in the mesentery of the transverse colon was sutured with several sutures. Imposed inter-intestinal anastomosis according to Roux distal to pancreatojejunoanastomosis by 40-45 cm. Drainage of the abdominal wall, suturing the wound of the abdominal wall. The postoperative period was uneventful, the wound healed by primary intention.

Thus, the method according to the invention allows:

1) crush and remove calculi both in the Wirsung duct and in the pancreatic parenchyma;

2) crush and remove calculi in the distal part, then the line of dissection of the Wirsung duct in order to improve the outflow from the tail of the pancreas;

3) crush and remove calculi in the proximal part of the Wirsung duct before passing the instrument at the mouth of the main pancreatic duct in order to improve the outflow from the ducts of the 1st order of the head of the pancreas;

4) remove parts of the upper and lower walls of the Wirsung duct in order to open the ducts of the I-II order;

5) expand the opened Wirsung duct at the border of the head and body up to 1.5-1.8 cm according to the type of Frey's operation, which allows the pancreatojejunoanastomosis not to be obliterated for a longer time.

A method for the surgical treatment of chronic calculous pancreatitis by opening and dissecting the main pancreatic duct, removing stones from the lumen of the duct and the pancreatic parenchyma, applying a retrocolic longitudinal pancreatojejunoanastomosis and Roux-en-Y interintestinal anastomosis, characterized in that an ultrasonic dissector removes part of the upper and lower walls of the main pancreatic duct with opening of the lumen of the ducts of the I-II order, crushing and removal of calculi in the duct and pancreatic parenchyma, crushing and removal of calculi in the tail of the pancreas, then the line of dissection of the duct, crushing and removal of calculi in the proximal part of the duct before passing the instrument at the mouth of the main pancreatic duct, after which, at the border of the head and body of the pancreas, the opened main pancreatic duct is expanded to 1.5-1.8 cm according to the Frey operation.

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The invention relates to medicine, namely to cardiac surgery. Retroperitoneal mini-access to the iliac arteries is carried out through a skin incision on the right, from the edge of the costal arch along the anterior axillary line towards a point 2 cm below the navel, 10-12 cm long, the lower edge of the incision ends at the edge of the rectus abdominis muscle. Dissect the subcutaneous fat, aponeuroses of the external oblique, internal oblique and transverse muscles. The medial portion of the muscles is retracted inside, the transverse fascia is opened. The parietal peritoneum is exfoliated with a tupfer and retracted medially. Distinguish between the terminal aorta and the right common iliac artery. The terminal section of the aorta is squeezed parietal, a lumen is opened with a longitudinal incision, a synthetic explant "Gore-Tech" 10 cm long is implanted, an introducer 18 French is installed in the proximal end of the prosthesis. Perform transcatheter implantation aortic valve. EFFECT: method makes it possible to perform aortic valve replacement in patients with small diameter of femoral arteries less than 6.5 mm when it is impossible to use subclavian, transaortic and transapical approaches. 2 ill., 1 pr.

The invention relates to medicine, surgery. When suturing a perforated duodenal ulcer, Tachocomb plates are used. A nasointestinal probe with a duodenal balloon is passed into the small intestine. A Tachocomb plate is installed on the front surface of the cylinder. The balloon is inflated and the plate is compressed in the region of the seam line. The stomach is decompressed and drained through 3-4 lateral holes proximal to the duodenal balloon in the gastric part of the probe. Decompression and drainage of the small intestine is carried out through multiple lateral holes distal to the duodenal balloon for 60 cm. In the presence of a "mirror" ulcer rear wall of the duodenum, its surface is covered with a plate of "Tachocomb". A duodenal balloon provides compression of both plates. EFFECT: method provides prevention of postoperative complications due to reliable hemostasis, effective drainage and decompression around the defect zone initial department duodenum. 1 z.p. f-ly, 2 ill., 1 pr.

The invention relates to medicine, surgery. Under ultrasound guidance, a puncture and opening of the main pancreatic duct is performed. An ultrasonic dissector removes part of the upper and lower walls of the duct. Stones are crushed and removed in the duct, in the parenchyma in the tail, further along the duct dissection line and in the proximal part of the duct before the instrument passes through its mouth. At the border of the head and body of the gland, the duct is expanded to 1.5-1.8 cm, similar to Frey's operation. Impose a longitudinal pancreatojejunostomy. Roux-en-Y interintestinal anastomosis is formed. EFFECT: method enables outflow of pancreatic juice through the pancreatojejunoanastomosis and through the restored orifice of the Wirsung duct, reduces severe pain in patients with chronic calculous pancreatitis, and reduces the risk of obliteration of the pancreatojejunoanastomosis. 1 ave.