Сравнительный анализ результатов хирургического лечения хронического панкреатита

Abstract

Aim of study. To compare short-term and long-term outcomes of surgical treatment for patients with chronic pancreatitis. Material and methods. In the period of 2002-2020, a total of 123 patients underwent surgery for treatment of complications associated with chronic pancreatitis. The patients were divided into three groups depending on the type of intervention. Patients in Group 1 underwent drainage (n=46), patients in Group 2 underwent resection (n=26) and patients in Group 3 combined resection and draining procedures (n=51). Results. After Roux-en-Y cystojejunostomy of cysts in distal parts of the pancreas(n=11), the amount of complications was lower (3 (27 [6; 61]%)) than after distal resection (n=20): 10 (50 [27; 73]%)), and the quality of life (SF-36) was higher in the long term (PSC: 55.75, MCS: 53.53 against PCS: 48.09, MCS – 49,72) after resection repair. The frequency of postoperative complications and lethality rate were higher in patients after different variants of sparing resection of pancreatic parenchyma with duct system drainage than in the group of patients treated with longitudinal cystojejunostomy. In the long term, lower lethality (5 [0; 23]%; p<0.05) and a higher level of physical (PCS – 61.31) and mental (MCS – 61.73) health were registered after the original variant of combined resection and draining intervention in comparison with traditional pancreatojejunostomy and duodenum-preserving surgery. Conclusion. Draining interventions on pancreatic cysts in distal parts of the pancreas is accompanied by better immediate and long-term results. Drainage without consideration for changes in the pancreatic head leads to a higher recurrence rate (27 [8; 55]%, р=0.013). Immediate results of the proposed combined resection and draining intervention are comparable with duodenum-preserving surgery but are characterised by lower mortality (5 [0; 23]%, р=0.06) and higher quality of life (SF-36) in the long term.