Journal of Experimental and Clinical SurgeryJournal of Experimental and Clinical Surgery2070-478X2409-143XVoronezh State Medical University106710.18499/2070-478X-2011-4-1-51-56UnknownThe role of organo-tissue barriers in the formation of a systemic inflammatory reaction and neutralize toxins in pancreatic necrosis, the choice of rational tactics surgical treatmentLubyankaVladimir Grigoryevich<p>MD, Professor, head of Department of hospital surgery</p>maks220382@mail.ruChernenkoVictor Fedorovich<p> doctor of medical Sciences, Professor Department of hospital surgery</p>maks220382@mail.ruAlievAleksandr Hrustevich<p> MD, PhD, associate Professor ka-Phaedra hospital surgery</p>maks220382@mail.ruZharikovAndrey Nikolaevich<p> PhD in medical Sciences, assistant <br />Department of hospital surgery</p>maks220382@mail.ruYelchaninovaSvetlana Aleksandrovna<p> doctor of medical Sciences, <br />Professor, head of Department of biochemistry</p>maks220382@mail.ruMishchenkoAlexander Nikolaevich<p> doctor of Department of <br />x-ray surgery</p>maks220382@mail.ruAltai state medical UniversityRegional clinical hospital, Barnaul1901201141515621082017Copyright © , Lubyanka V.G., Chernenko V.F., Aliev A.H., Zharikov A.N., Yelchaninova S.A., Mishchenko A.N.<p>Despite the intensive development of the diagnosis and surgical treatment of pancreatic necrosis (PN), mortality remains <br />high, reaching 30-50% or more. This is due, on the one hand, with insufficient study of the mechanisms pancreatogenic <br />toxemia, generalized infection, manifestations of the Systemic Inflammatory Response (SIR) and the role of organ-tissue <br />barriers in the neutralization of toxins (the liver, lungs, muscles and cellulate array), on the other hand, the ineffectiveness <br />of drugs in their system application as a result of blocking organ microcirculation and limiting their availability. As a result, <br />research has found evidence of the complexity of the SIR and the mechanisms of toxemia in the PN (enzymatic, metabolic <br />and bacterial), which showed a high level of leukocytosis, the study of enzymes, especially when infected Mon, reflecting the <br />morphological and functional liver damage, as the primary detoxification barrier pancreatogenic aggression. These humoral <br />indicators can serve when they raise specific markers of the severity of toxemia and SIR. Application regional arterial drug <br />therapy provider medicinal effect is in the region of defeat, can achieve better results in reducing mortality in Mon, compared <br />with traditional methods of treatment.</p>pancreatic necrosis, regional arterial drug therapyпанкреонекрозрегионарная артериальная лекарственная терапия[1. Байчоров Э.Х., Макушкин Р.С., Байрамуков Р.Р., Оганесян А.В. Этапность оказания хирургической помощи при остром деструктивном панкреатите. Вестник экспериментальной и клинической хирургии 2010; 3: 4:323-326.][2. Вискунов В..Г. Федоренко В.П., Проценко С.И. Роль поджелудочной железы в развитии реакции ограниченного][протеолиза. Вестник экспериментальной и клинической хирургии 2010; 3: 4: 418-420.][3. Григорьев Е.Г. и др. Некротический мезо- и параколит в терминальной стадии инфицированного панкреонекроза . Инфекции в хирургии 2008; 6; 4: 38-43.][4. Глушко В.А. Панкреонекроз и его осложнения, основные принципы хирургической тактики. Хирургия 2003; 3: 23-31.][5. Лубянский В.Г. и др. Лечение и профилактика инфицированных форм и осложнений панкреонекроза с применением регионарной внутриартериальной инфузии.][Вестник хирургии 2003; 162; 5: 69-74.][6. Меньшиков В.В. Методики клинических лабораторных исследований. Справочное пособие. М.: Лабора 2009; 2; 304.][7. Нестеренко Ю.А. и др. Диагностика и лечение деструктивного панкреатита. М.: "Бином. Пресс" 2004; 304.][8. Савельев В.С. и др. Острый панкреатит как проблема][ургентной хирургии и интенсивной терапии. Consilium Medicum 2000; 2; 9: 24-32.][9. Савельев В.С. и др. Деструктивный панкреатит. Стандарты диагностики и лечения. Анналы хирургической гепатологии 2001; 6; 2: 115-122.][10. Савельев В.С. Руководство по неотложной хирургии органов брюшной полости. М. 2004; 420.][11. Саенко В.Ф. и др. Антибактериальная терапия панкреонекроза. Клінічна хірургія 2001; 3: 5-9.][12. Чернов В.Н. Бойко А.А. Тактика лечения больных острым панкреатитом в зависимости от степени выраженности эндотоксикоза. Вестник экспериментальной и клинической хирургии 2009; 2: 4: 272-276.][13. Baron T.H. et al. Acute necrotizing pancreatitis. New Engl. J. Med. 1999; 340: 1412-1417.][14. Beger H.Y. et al. Antibiotic Prophylaxys in Severe Pancreatitis. Pancreatology 2005.; 5: 10-19.][15. Beger H.Y. et al. Antibiotic Prophylaxis in Severe Acute][Pancreatitis May Not Improve Outcomes. Gastroenterology][2004; 127: 997-1004.][16. Dufour D. R., Lott J.A., Nolte F.S. et al. Diagnosis and Monitoring of Hepatic Injury. II. Recommendations for Use of Laboratory Tests in Screening, Diagnosis, and Monitoring Clinical. Chemistry 2000; 46: 2050-2068.][17. Isenmann W.R. et al. Infections complicating pancreatitis:][diagnosing, treating, preventing. New Horiz 1998; 6: 72-90.][18. Lillemoe D.K. et al. M anagement o f c omplications o f pancreatitis. Curr Probl Surg. 199.; 35: 1-98.][19. Rau B., Uhl W., Buchler M.W., Beger H.J. Surgical treatment][of infected necrosis. World J Surg 1997; 21: 155-161.][20. Tonsi A.F. Acute pancreatitis at the beginning of the 21st][century. The state of the art. World J Gastroenterol 2009; 28: 15(24): 2945-2959.]