POSSIBILITIES OF SURGICAL TREATMENT OF PATIENTS WITH ACUTE PANCREATITIS OF THE HEAVY DEGREE IN CONDITIONS OF SPECIALIZED DEPARTMENT OF REGIONAL CLINICAL HOSPITAL
1The State Health Institution «Sverdlovsk Regional Clinical Hospital № 1», Ekaterinburg, Russia
2Department of Surgical Diseases FAT and PP of FSBEI HE «Ural State Medical University», Ekaterinburg, Russia
Objective: To analyze the results of treatment of patients with acute pancreatitis of the heavy degree (APHD) in the conditions of a specialized department of the regional clinical hospital.
Methods: The results of diagnostics and treatment of 1230 patients of APHD in the Department of Purulent Surgery (DPS) are presented. In accordance with the routing of patients, the APHD was provided, the first phase of the disease in the intensive care units of inter-district centers was financed and methodically provided. After arresting the phenomena of pancreatogenic shock and the appearance of infections, the patients were transferred to the Sverdlovsk Regional Clinical Hospital № 1.
Results: Infected peripancreatic infiltrates occurred in 173 patients. In 23 patients, an attempt of draining way was through the surgical separation of the infiltrate. Mortality rate was 52.2%. One hundred thirty nine patients were treated only conservatively, lethality was 5.8%. Pancreatogenic abscesses occurred in 221 patients, they were given navigational punctures with the aspiration of the contents, puncture drainage and drainage from the mini-accesses. Unopened variants of pancreatogenic septic sequestration of retroperitoneal tissue were detected in 836 patients. These patients were operated without using wide incisions. Mortality in this group was 24.5%. Patients of APHD in the phase of unlimited septic sequestration are given pre-treatment for the terminal drainage, which is possible at the place of occurrence of the case. The primary operation was performed in the zone of the greatest change in the retroperitoneal space, in most cases through the omentobursostomy. The remaining foci of unlimited septic sequestration were drained after stabilization of the state in the conditions of a specialized department.
Conclusions: Regional routing of patients with APHD made it possible to effectively use the capabilities of surgical hospitals of different levels when providing assistance to patients with APHD. Patients with acute pancreatitis of the heavy degree in the phase of unlimited septic sequestration should be given a gradual drainage, which is possible in the place of occurrence of the case. The primary operation can be performed in the zone of the greatest changes in the retroperitoneal space (in most cases) through the omentobursostomy at the stage of surgical care. The remaining foci of unlimited septic sequestration can be drained after stabilization of the condition in the conditions of a specialized department.
Keywords: Acute pancreatitis of the heavy degree, routing, diagnostics, FGD, ultrasound, stage drainage, CT.
- Avakimyan SV. Prognoz i khirurgicheskaya taktika pri ostrom destructivnom pankreatite [Prognosis and surgical tactics in cases of acute pancreatitis]. Kubanskiy nauchnyy vestnik. 2013;3(138):11-6.
- Andreev AV, Ivshin VG, Goltsov VR. Lechenie infitsirovannogo pankreonekroza s pomoshch’yu miniinvazivnykh vmeshatel’stv [Miniinvasive surgery in treatment of pancreonecrosis]. Annaly khirurgicheskoy gepatologii. 2015;3:110-6.
- Galimzyanov FV, Prudkov MI, Shapovalova OP. Khirurgicheskaya taktika pri infektsionno-vospalitel’nykh oslozhneniyakh pankreonekroza [Surgery tactics in complications of pancreonecrosis]. Al’manakh Instituta khirurgii imeni A.V. Vishnevskogo. 2012;1:98.
- Prudkov MI, Galimzyanov FV. Evolyutsiya infitsirovannogo pankreonekroza, topicheskaya diagnostika i lechenie gnoynykh oslozhneniy [Evolution of infected pancreonecrosis, topical diagnosis and treatment of purulent complications]. Annaly khirurgicheskoy gepatologii. 2012;2:42-9.
- Lubyanskiy VG, Bykov VM, Yatsyn AM, Ustinov DN, Zharikov AN, Aliev AR, i dr. Formirovanie tkanevogo otgranichitel’nogo bar’era v zabryushinnoy kletchatke pri pankreonekroze [Formation of a tissue barrier in retroperitoneal spatium in pancreonecrosis]. Annaly khorurgicheskoy gepatologii. 2012;4:99-105.
- Freeman ML, Werner J, van Santvoort HC, Baron TH, Besselink MG, Windsor JA, et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas. 2012;41(8):1176- 94. Available from: http://dx.doi.org/10.1097.MPA.0b013e318269c660. PMID:23086243.
- Philip S, Gandhi V. Analysis of the delayed approach to the management of infected pancreatic necrosis. World J Gastroenterol. 2011;17(3):366-71.
- Horvath K, Freeny P, Escallon J, Heagerty P, Comstock B, Glickerman DJ, et al. Safety and efficacy of video-assisted retroperitoneal debridement for infected pancreatic collections: A multicenter, prospective, single-arm phase 2 study. Arch Surg. 2010;145(9):817-25.
- Dyuzheva TG, Dzhus EV, Shefer AV, Akhaladze GG, Chevokin AYu, Kotovskiy AE, i dr. Konfiguratsiya nekroza podzheludochnoy zhelezy i differentsirovannoe lechenie ostrogo pankreatita [Configuration of pancreonecrosis and differentiated treatment of acute pancreatitis]. Annaly khirurgicheskoy gepatologii. 2013;18(1):92-102.
- Chernov VN, Belik BM, Alibekov AZ. Lechenie infitsirovannykh form destruktivnogo pankreatita s ispol’zovaniem maloinvasivnykh tekhnologiy [Treatment of infected pancreonecrosis with using of miniinvasive technologies]. Novosti khirurgii. 2014;22(1):63-7.
- Shapovalyants SG, Mylnikov AG, Pankov AG. Operativnye vmeshatel’stva pri ostrom destruktivnom pankreatite [Surgery of acute destructive pancreatitis]. Annaly khirurgicheskoy gepatologii. 2010;2:58-65.
- Vetshev PS, Musaev GH, Bruslik SV. Miniinvazivnye chreskozhnye tekhnologii: istoriya, traditsii, negativnye tendentsii i perspectivy [Miniinvasive percutaneos technologies: hystory, traditions, negative trends and perspectives]. Annaly khirurgicheskoy gepatologii. 2014;1:12-6.
- Bagnenko SF, Blagovestnov DA, Galperin EI, Dyuzheva TG, Dibirov MD, Prudkov MI, i dr. Ostryy pankreatit (protocol, diagnostika i lechenie) [Acute pancreatits (protocols, diagnosis and treatment)] [Elektronnyy resurs]. 2014. [data obrashcheniya 14.11.2014]. Rezhim dostupa: http:pancreonecrosis.ru/ ostriy-pankreatit-protokoli-diag.
- Belik BM, Chernov VN, Alibekov AZ. Vybor lechebnoy taktiki u bol’nykh ostrym destructivnym pankreatitom [Choice of tactic in cases of acute destructive pancreatitis]. Khirurgiya. 2015;6:26-31.
- Shabunin AV, Lukin AYu. Shikov DV. Optimal’noe lechenie ostrogo pankreatita v zavisimosti ot «modeli» pankreonekroza [Optimal treatment of acute pancreatitis in dependence of «pattern» of pancreonecrosis]. Annaly khirurgicheskoy gepatologii. 2013;3:70-8.
- Navalho M, Pires F, Duarte A, Goncalves A, Alexandrino P, Tavora I. Percutaneous drainage of infected pancreatic fluid collections in critically ill patients: correlation with C-reactive protein values. Clin Imaging. 2006;30(2):114-9.
Galimzyanov Farid Vagizovich, Doctor of Medical Sciences, Full Professor, Head of the Department of Purulent Surgery of Sverdlovsk Regional Clinical Hospital № 1
Gafurov Bahromjon Bobojonovich, Postgraduate Student of the Department of Surgical Diseases, Faculty of Advanced Training and Professional Preparation of the Ural State Medical University
Address for correspondence:
Galimzyanov Farid Vagizovich
Doctor of Medical Sciences, Full Professor, Head of the Department of Purulent Surgery of Sverdlovsk Regional Clinical Hospital № 1
620120, Russian Federation, Ekaterinburg, str. Volgogradskaya, 185
Tel.: (+7) 343 351 1556
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