MD, professor of surgery, Faculty of postgraduate professional training of physicians, sechenov First Moscow state medical university
д.м.н., проф., зав. кафедрой хирургии ФППоВ Первого Московского государственного медицинского университета им. И.М. Сеченова
Phd, assistant in the department of surgery, Faculty of postgraduate professional training of physicians, sechenov First moscow state medical university
к.м.н., асс. кафедры хирургии ФППоВ Первого Московского государственного медицинского университета им. И.М. Сеченова
postgraduate, Chair of surgery, Faculty of postgraduate professional training of physicians, sechenov First moscow state medical university
Очный аспирант кафедры хирургии ФППоВ Первого Московского государственного медицинского университета им. И.М.Сеченова
postgraduate, Chair of surgery, Faculty of postgraduate professional training of physicians, sechenov First moscow state medical university
Очный аспирант кафедры хирургии ФППоВ Первого Московского государственного медицинского университета им. И.М. Сеченова
surgeon of the clinical hospital № 53, moscow
врач–хирург хирургического отделения, Городская клиническая больница №53 г. Москвы
surgeon of the clinical hospital № 53, moscow
врач–хирург хирургического отделения, Городская клиническая больница №53 г. Москвы
Faculty of postgraduate professional training of physicians, chair of surgery, sechenov First moscow state medical university., resident of doctor
Клинический ординатор кафедры хирургии ФППоВ Первого Московского государственного медицинского университета им. И.М. Сеченова
chief of Department of intensive Care, clinical hospital № 53, moscow
зав. отделением реанимации, Городская клиническая больница №53 г. Москвы
Relevance The need to determine the frequency of occurrence of a speciŸc type of complication of "open" operations in severe pancreatitis, the timeliness of their recognition, the deŸnition of the indications for surgical or conservative treatment of intraoperative and early postoperative complications, the choice of surgical methods, the development of principles of postoperative management and rehabilitation of such patients. The purpose of the study Was to improve the results of the use of "open" surgery in patients with acute severe pancreatitis.Materials and Methods 6844 patients with acute pancreatitis were under surveillance for the last 20 years. 493 (7,3%) of them underwent surgical treatment. 322 had an "open" operative intervention, and in 102 (31.6%) identiŸed 197 intraoperative or early postoperative complications. Lien trauma was revealed intraoperationally with 7 patients, 3 cyst bleeding after dissection, 1 splenic artery bleeding and 1 parenchymal splenic bleeding. Among the early postoperative complications were revealed: arrosive hemorrhage 30,8%; pancreatic Ÿstulas 19,1%; hollow organ Ÿstulas – stomach 7,4%, duodenum 5,3%, small intestine 3,2%, colon 12,7%, cystoduodenal Ÿstulas 2,1%, stomach phlegmon 2,1%, acute cholecystitis 1,06%, trombotic complications 3,2%, purulent pleuritis 1,06%. Results and their discussion The main reason for acute severe pancreatitis intra and early post open packing operation complications are the inŸltration process on the intervention area, the involvement of the hollow organ wall into the purulent process, vessel deformation and the destruction of the pancreatic duct disruption. The primary prophylactic measures of the complications are adequate access, certain intraoperative tissue differentiation, unconŸned sequestrum elimination without force, the rejection of the acute removal of the necrotic tissues and the sanation relaparotomy with the application of local anesthesia each 48-72 hours.
The treatment tactics of the open packing operation complications is quite diversiŸed and can be either conservative or operative, palliative or resective and depend on the local changes in the intervention area and polyorganic deŸciency presence.
Conclusion The results of the treatment “open” packing operations complications in severe acute pancreatitis are achieved through
the use of our clinical guidelines developed in the management of patients with severe acute pancreatitis in all phases of treatment.
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