Differentiated Medical and Diagnostic Tactics at Acute Destructive Pancreatitis

Abstract


The purpose of the study To analyse results of treatment of patients with sharp destructive pancreatitis and to define the most effective methods of various draining operations with the purpose of reduction of number of complications, decrease in a lethality and improvement of outcomes of a disease. Materials and methods The basis of research was made by results of inspection and treatment of 256 patients by destructive forms of sharp pancreatitis, the postupivkshikh on treatment in No. 23 GKB of "Medsantrud" during the period with 2010 on 2014гг concerning sharp pancreatitis. In studied group didn't include biliarny and postoperative панкреонекрозы because of features па- тогенеза and a clinical current. The age of patients varied from 18 to 90 years and averaged 51,0±15,2. It was more senior than 60 years of 27,4% of the patients who had a serious accompanying illness among which pathology prevailed from serdechnoksosudisty (at 66,3%) and respiratory systems (at 37,4%) that is considerable отягощало their state and a current of the postoperative period. Results and their discussion Sharp destructive pancreatitis develops in 45% of cases within a pancreas and parapankreatichesky cellulose also has focal character. At 37,7% of patients destruction gains massive character with distribution on zabryushinny cellulose. Lightning techekny diseases total and subtotal destruction of a pancreas and involvement in process of all bodies and systems meets at 17,3% of patients. The medical and diagnostic laparoscopy and low-invasive methods of research with the subsequent "closed" drainage of the centers of destruction allows to reduce manifestation of endogenous intoxication at patients with sharp pancreatitis. At focal панкреонекрозе the medical and diagnostic laparoscopy and mininvazivny methods of drainage is a zaverkshayushchy type of expeditious treatment and allows to reduce number of purulent complications to 11,1%, all-somatic - to 6,6%, and a lethality to 1,1%. Conclusion The differentiated approach to surgical tactics of treatment of patients by destructive pancreatitis, depending on the scale of initial damage of a pancreas, allowed to reduce on the average number of purulent complications by one patient by 4 times (from 9,8% to 2,2%), to lower a lektalnost from purulent complications by 3 times (from 15,3% to 5,5%), and, as a result, to lower a postoperative lethality by 2,5 times (from 25,0% to 9,8%).

I.M. Sechenov First Moscow State Medical University, 8/2 Trubetskaia Str., Moscow, 119991, Russian Federation

Author for correspondence.
Email: author@vestnik-surgery.com

Russian Federation MD, the prof., the chief physician of 23 City Clinical Hospital of "MEDSANTRUD"

I.M. Sechenov First Moscow State Medical University, 8/2 Trubetskaia Str., Moscow, 119991, Russian Federation

Email: author@vestnik-surgery.com

Russian Federation MD, prof. Department of General Surgery of the First MGMU named after IM Sechenov, Head of the 3rd surgical department of 23 City Clinical Hospital of "MEDSANTRUD"

I.M. Sechenov First Moscow State Medical University, 8/2 Trubetskaia Str., Moscow, 119991, Russian Federation

Email: author@vestnik-surgery.com

Russian Federation MD; Assistant of the Department of General Surgery of the First MGMU named after IM Sechenov, surgeon of the third surgical department of 23 City Clinical Hospital of «MEDSANTRUD»

I.M. Sechenov First Moscow State Medical University, 8/2 Trubetskaia Str., Moscow, 119991, Russian Federation

Email: author@vestnik-surgery.com

Russian Federation Assistant of the Department of General Surgery of the First MGMU named after IM Sechenov, surgeon of the third surgical department of 23 City Clinical Hospital of «MEDSANTRUD»

I.M. Sechenov First Moscow State Medical University, 8/2 Trubetskaia Str., Moscow, 119991, Russian Federation

Email: author@vestnik-surgery.com

Russian Federation Head of the Department of Anesthesiology and Resuscitation department of 23 City Clinical Hospital of «MEDSANTRUD»

  • Aleksandrova D. A. Lechenie pankreonekroza s uchetom variantov destrukcii podzheludochnoj zhelezy i zabryushinnogo prostranstva. Voenno-medicinskij zhurnal, [Treatment of pancreatic necrosis considering options of destruction of the pancreas and retroperitoneal space. Military medical journal,] 2003; 9-60.
  • Afendulov S. A., Zhuravlev G. IU., Gadzhiev A. U., In Nasala.And."Maloinvazivnye tekhnologii v kompleksnom lechenii pankreonekroza". XII Vserossijskogo s"ezda ehndoskopicheskih hirurgov. Moskva, ["Minimally invasive technologies in complex treatment of pancreatic necrosis". XII all-Russian Congress of endoscopic surgeons. Moscow,] 2009; 119.
  • Briskin B. S., Ribakov G. S., Khalidov.X. et al. Taktika gnojno-septicheskih oslozhnenij pankreonekroza. Materialy Kongressa "tretij Kongress Associacii hirurgov im. N. I. Pirogova". Moskva, [Tactics of purulent-septic complications of pancreatic necrosis. The proceedings of the Congress "the Third Congress of the Association of surgeons them. N. And. Pirogov". Moscow,] 2001; 105.
  • Galperin E. I., Dokuchaev K. V., Pogosyan G. S. et al. Pancrea, i parapankreatita: kogda rabotat' i chto delat'? Materialy Kongressa "na IX Vserossijskij s"ezd hirurgov". Volgograd [Pancrea, and parapancreas: when to operate and what to do? Proceedings of the Congress "at the IX all-Russian Congress of surgeons". Volgograd,] September 20-22, 2000; 31.
  • In Gostishchev.To., In Glushko.And. Pankreonekroz i ego oslozhneniya, osnovnye principy hirurgicheskoj taktiki. Hirurgiya [Pankreonekros and its complications, basic principles of surgical tactics. Surgery] 2003; 3: 50-54.
  • Zatevakhin I. I., tsitsiashvili M. sh., M. D. Bodurov Diagnostika i lechenie pankreonekroza: reshennye i nereshennye voprosy. Materialy Kongressa "na IX Vserossijskij s"ezd hirurgov". Volgograd, Sentyabr' [Diagnostika and treatment of pancreatic necrosis: resolved and unresolved issues. Proceedings of the Congress "at the IX all-Russian Congress of surgeons". Volgograd, September] 20-22, 2000; 48-49.
  • Lysenko M. V., S. V.-Hungry, Psycho.G., Chizh S. I., gritsyuk A. M., Litovchenko G. Y. Differencirovannaya lechebno-diagnosticheskaya taktika pri ostrom pankreatite. M.: gvkg im. N. N. Burdenko [Differentiated treatment and diagnostic tactics in acute pancreatitis. M.: gvkg them. N. N. Burdenko] 2007,; 10-14.
  • Prudkov M. I., Shulutko A. M., Galimzyanov F. V., Levit A. L. Minimal'no invazivnaya hirurgiya nekrotiziruyushchego pankreatita. Rukovodstvo dlya vrachej. Ekaterinburg, [Minimally invasive surgery of necrotizing pancreatitis. Manual for doctors. Yekaterinburg,] 2001; 47.
  • Pugaev A.V., Shipilov D.In., Travnikova N. L. etc. and Ocenka punkcionnogo lecheniya lozhnyh kist podzheludochnoj zhelezy. Annaly hirurgicheskoj gepatologii. Tula [the Estimation of puncture treatment of false cysts of the pancreas. The annals of surgical Hepatology. Tula,] 1996; 1: 165.
  • And Horbunov.With., Dr. Sorokin.To., Piskun A. B. Rol' maloinvazivnyh hirurgicheskih vmeshatel'stv v lechenii ostrogo destruktivnogo pankreatita" v ramkah XII Vserossijskogo s"ezda ehndoskopicheskih hirurgov. Moskva, [the Role of minimally invasive surgical interventions in treatment of acute destructive pancreatitis" at the XII all-Russian Congress of endoscopic surgeons. Moscow,] 2009; 78.
  • Savelyev V. S., Gelfand B. R., Filimonov M. I. Inficirovannyj pankreonekroz. Infekcii v hirurgii, [Infected pancreatic necrosis. Infection in surgery,] 2003; 1,2: 34-39.
  • Glor, B. W. UHL, Mueller K. A. et al. Rol' hirurgii v lechenii ostrogo pankreatita. [The role of surgery in the treatment of acute pancreatitis.] Can J Gastroenterol. 2004; 14 EXT.
  • Hamand, G. G., Broderick T. J. Laparoskopiya podzheludochnoj nekrehktomii. [Laparoscopic pancreatic necrosectomy.] AM.

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