Abstract
Aim. To examine the effectiveness of minimally invasive interventions for infected pancreatic necrosis (purulent necrotic parapancreatitis). Material and Methods. A simple comparative multicenter study included 270 patients with infected pancreatic necrosis who were treated for the period from 2004 to 2013. Paients were divided into three groups: 1 group – 90 patients who underwent only remedial laparotomy. 2 group – 90 patients who had minimally invasive drainage as the first stage followed by subsequent remedial laparotomy. 3 group – 90 patients with only minimally invasive drainage. Patients distribution by age, comorbidities, severity of purulent necrotic parapancreatitis and therapeutic medical complex was homogeneous. Results. There were maximal incidence of complications (digestive fistula, bleeding, RDS, severe sepsis) and mortality rate in group 1. In group 2 there was a tendency to decrease of morbidity and mortality in infected pancreatic necrosis patients although their level remained high. Minimally invasive interventions (3 group) for infected pancreatic necrosis resulted significant reduction of morbidity and mortality. Conclusion. Minimally invasive techniques should be preferred for primary drainage of infected pancreatic necrosis (purulent necrotic parapancreatitis). Laparotomy with necrosectomy is necessary in case of ineffectiveness of minimally invasive drainage or appearance of complications that can not be treated using minimally invasive interventions
Highlights
Paients were divided into three groups: 1 group – 90 patients who underwent only remedial laparotomy. 2 group – 90 patients who had minimally invasive drainage as the first stage followed by subsequent remedial laparotomy. 3 group – 90 patients with only minimally invasive drainage
Андреев Андрей Викторович – доктор мед. наук, заведующий отделением рентгенохирургических и ультразвуковых методов диагностики и лечения ГБУЗ “Краевая клиническая больница No 2”, г
Dellinger E.P., Forsmark C.E., Layer P., Levy P., Maravi-Poma E., Petrov M.S., Shimosegawa T., Siriwardena A.K., Uomo G., Whitcomb D.C., Windsor J.A. Determinant based classification of acute pancreatitis severity: an international multidisciplinary consultation
Summary
Изучить эффективность применения миниинвазивных вмешательств при инфицированном панкреонекрозе (гнойно-некротическом парапанкреатите). Распределение больных в группах по возрасту, преморбидному фону, распространенности гнойно-некротического парапанкреатита, терапевтическому лечебному комплексу было однородным. В 1-й группе отмечена максимальная частота осложнений (дигестивный свищ, кровотечение, респираторный дистресс-синдром взрослых, тяжелый сепсис) и летальности у больных инфицированным панкреонекрозом. Во 2-й группе отмечена тенденция к уменьшению частоты осложнений и смертности, хотя их уровень оставался достаточно высоким. Применение миниинвазивных вмешательств (3-я группа) при инфицированном панкреонекрозе приводило к достоверному уменьшению частоты осложнений и летальности. При уточнении показаний к первичному дренированию инфицированного панкреонекроза (гнойно-некротического парапанкреатита) следует отдавать предпочтение миниинвазивным вмешательствам. При неэффективности миниинвазивного дренирования или развитии осложнений, которые невозможно купировать миниинвазивными вмешательствами, необходима лапаротомия с некрсеквестрэктомией.
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