Ранняя реологическая лекарственная терапия и стимуляция процессов отграничения у больных острым панкреатитом

Abstract

The results of surgical treatment of 470 patients with acute pancreatitis of severe severity were studied. Out of 314 patients with infected pancreatonecrosis, 224 had retroperitoneal phlegmon and 90 - parapancreal abscesses. In this group of patients, early surgical treatment was used in the first 3-5 days from the time of admission. In all cases in the process of laparotomy open necrectomy and drainage were performed. In 156 patients of the second group, a savings technology was used for 4-8 weeks, aimed at distinguishing the purulent-necrotic process. Of these, 98 had local intra-arterial rheological therapy, 46 had early video laparoscopic drainage, and 12 had decompression retroperitoneal drainage. As soon as the delimitation (formation of the fluid cluster, parapancreatic cyst, abscess) was achieved, in 4-6 weeks in this group, minimally invasive transabdominal or transgastral drainage was performed and only open operations on demand were carried out with the progression of the purulent-necrotic process. The results of the treatment showed high mortality in the early extended operations in the first group of patients. With retroperitoneal phlegmon it reached 55.4 %. Savings tactics aimed at limiting the process in the retroperitoneal tissue and subsequent minimally invasive drainage, was characterized by a lower mortality - 31 (19.9 %) patient. Early video laparoscopic drainage of the abdominal cavity and retroperitoneal space (mortality - 10.9 %) and local rheological drug therapy (mortality - 21.4 %) were the most effective among the minimally invasive technologies of surgical treatment of pancreonecrosis, which facilitated the accelerated formation of the delimitation of the inflammatory process in the pancreas and retroperitoneal space.