Abstract
Aim. To study pancreatic changes in acute pancreatitis with internal pancreatic fistula and to assess the results of retroperitoneoscopic sanations for this pathology. Material and Methods. Contrast-enhanced CT was made in 30 patients. Localization and depth of necrosis were evaluated in sagittal, axial and coronal sections. Swelling and infiltration of retroperitoneal fat up to pelvic floor aperture were the criteria for evaluating severity of retroperitoneal fat lesion. All patients were divided into two groups. The first group included 15 patients with pancreatic head or isthmus necrosis and viable parenchyma of body and tail who underwent retroperitoneoscopic drainage of retroperitoneal fat in 4–5 hours after disease onset. The second group consisted of 15 patients with various forms of pancreatic necrosis who were operated only at the stage of infected pancreatic necrosis. Results. In the first group hospital-stay was 45 ± 5.3 days. External pancreatic fistula was observed in all patients that was closed within 4.8 ± 1.1 months after surgery. Deaths were absent. Postoperative ventral hernia was not observed. Pancreatic pseudocysts occurred in 3 (20%) patients. Mean hospital-stay in the second group was 80 ± 5.3 days, mortality rate – 33.3%. External pancreatic fistula formed in 2 (13%) patients, postoperative ventral hernia – in 3 (20%) cases, pancreatic pseudocyst – in 3 (20%) cases. Conclusion. Contrast-enhanced computed tomography visualizes internal pancreatic fistula and gives information for differentiated surgical approach in acute pancreatitis patients. External drainage of retroperitoneal fat is pathogenetically proved treatment of patients with internal pancreatic fistula and acute severe pancreatitis.
Highlights
Цель: изучить изменения поджелудочной железы при остром панкреатите с внутренним панкреатическим свищом и оценить результаты ретроперитонеоскопических санаций при этом состоянии
External pancreatic fistula formed in 2 (13%) patients, postoperative ventral hernia – in 3 (20%) cases, pancreatic pseudocyst – in 3 (20%) cases
Симптом “пузырьков газа” в парапанкреатической клетчатке отмечен в 3 (20%) наблюдениях
Summary
External pancreatic fistula formed in 2 (13%) patients, postoperative ventral hernia – in 3 (20%) cases, pancreatic pseudocyst – in 3 (20%) cases. External drainage of retroperitoneal fat is pathogenetically proved treatment of patients with internal pancreatic fistula and acute severe pancreatitis. Однако эти данные недостаточно используют в выборе способа и объема хирургического пособия при остром панкреатите тяжелой степени. Описали внутренний панкреатический свищ при глубоком некрозе перешейка ПЖ и предложили не дожидаться стадии инфицированного панкреонекроза, а выполнять ранние дренирующие операции забрюшинной клетчатки [3]. Предложили классификацию поражения забрюшинной клетчатки при остром панкреатите по пятибалльной шкале. Был опубликован патент РФ, в котором предложен способ предупреждения распространенного парапанкреонекроза при остром панкреатите тяжелой степени. При внутреннем панкреатическом свище патогенетически необходимо выполнить наружное дренирование – перевести свищ в наружный для декомпрессии забрюшинной клетчатки.
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