Diagnostic Tactics in Acute Destructive Pancreatitis

Relevance Acute destructive pancreatitis is one of the most serious diseases in emergency abdominal surgery. In Russia, in recent years there is a high incidence of acute pancreatitis (20-80 cases per 100,000 population). In a large proportion of patients (1530%) destructive forms of acute pancreatitis are registered. They are accompanied by development of septic and complications. In necrotizing pancreatitis a high mortality rate is registered – up to 25-40%, in cases accompanied by septic and systemic complications – up to 82%. The key aspects in management planning of patients with acute pancreatitis are to determine the severity of the pathological process, and the prediction of its further course, the probability of destructive forms and septic complications.

The purpose of the study The goals of the study – analysis of the results of the treatment of patients with acute destructive pancreatitis hospitalized in the surgical departments of Clinical Emergency Hospital in Smolensk

Materials and methods The diagnostic tactics in acute destructive pancreatitis at 129 patients hospitalized in Smolensk Clinical hospital of emergency medical service during the period 2008-2012 has been analysed. Used the data of clinical, laboratory and instrumental methods of investigation. Additionally, data of liver biopsy histological morphometric and immunohistochemical studies with the help of software system «Videotest 4.0» was used in 30 patients.

Results and their discussion Standard diagnostic methods for treatment control and identification of  demanding operation complications efficiency has been defined. On the material of liver biopsy specimens of 30 patients with necrotizing pancreatitis the relative square of macrophages and periportal B-lymphocytes was investigated. The relative square of macrophages in a sterile phase of acute destructive pancreatitis accepted values from 0,89 to 2,95 %, in a septic phase – from 4,34  to 9,52 %. The relative square taken by periportal B-lymphocytes in a micropreparation in sterile pancreonecrosis varied from 0,4 to 1,14 %, in a septic phase – from 1,41  to 4,98 %.

Conclusion The use of scales Ranson and APACHE II is not possible in all cases of destructive pancreatitis in hospitals of general surgery. Possibility of liver bioptates morphometry use with research of mentioned parameters as objective criteria for septic phase verification and treatment tactics correction, including operations, has been proved.