ANALYSIS OF THE STRUCTURE OF LOCAL COMPLICATIONS TO ACUTE NECROTIC PANCREATITIS USING RADIATION DIAGNOSTICS METHODS

Abstract

The use of multispiral computed tomography and ultrasound examination in pancreatic necrosis makes it possible to determine the shape, volume and localization, to distinguish four types of lesions. The aim of the study was to determine the incidence rate and the structure of local aseptic and purulent complications in acute necrotic pancreatitis using radiation diagnostics methods, to assess complications impact on the course and prognosis of the disease. Materials and methods. 63 patients with pancreatic necrosis who underwent treatment were examined during 2 years. The results of these examinations were analyzed. Two groups were identified: 1st – patients with infected pancreatic necrosis 29 (46%), 2nd – patients with sterile one 34 (54%). Ultrasound examination was performed on expert-class scanners, multispiral computed tomography with bolus tracking was performed on an Aguilion Prim device manufactured by Toshiba. Statistical processing of the results was performed in the Microsoft Excel 2017 database, the calculation of average values, standard distribution errors was made, the analysis of conjugate frequencies was given – the xi-squared test (c2) was used. Study results. Four types of infiltrative-necrotic lesions were identified: 21 cases (33.3%) of model-1 (central type); 13 cases (20.7%) of model-2 (left type); 9 cases (14.3%) of model-3 (right type); 20 cases (31.7%) of model-4 (mixed type). In group 1, severe pancreatic necrosis was significantly more often identified – in 17 out of 29 (58.6%) (c2 = 5.414; p = 0.020), mixed type (model-4) – 14 of 29 (48.3%) (c2 = 5.436; p = 0,020); in the 2nd group that of moderate severity was found more often – 21 out of 34 (61.6%) (c2 = 8.511; p = 0.004), mainly the central type (model-1) – 17 of 34 (50%) (c2 = 7.675; p = 0.006). There are no differences in the structure of local complications in group 2 depending on the severity of necrosis, in group 1, widespread parapancreatitis was more common in 22 out of 29 cases (75.9%) (p < 0.001). Mortality in infected and sterile pancreatic necrosis did not significantly differ – 24.1% and 23.5%, the highest mortality was in the mixed type of lesion in both groups (model-4) was 9 out of 20 (c2 = 5.643; p = 0.018). Conclusions. Radiation examination methods give the opportunity to predict early the pancreatic necrosis course and outcome. The development of local complications and their structure depend on the volume of necrosis, the prevalence and type of localization of destructive and inflammatory changes in retroperitoneal space.