Differentiated Medical and Diagnostic Tactics at Acute Destructive Pancreatitis

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%).

acute pancreatitis, surgical tactics, drainage