OPTIMIZATION OF SURGICAL TACTICS IN PATIENTS WITH POSTNECROTIC PANCREATIC CYSTS

Abstract

Summary. The predominance of people of working age (21–60 years) among patients with pancreatic necrosis, the occurrence of permanent disability in a significant part of patients, high overall and postoperative mortality (20–85 %), due to various complications, turns the treatment of pancreatic necrosis into an important social problem. The frequency of formation of false cysts in acute pancreatitis is 5–16 %, and in destructive forms it increases to 60–80 %.
 Materials and methods. The scope of endoscopic interventions in the treatment of 16 patients with pancreatic cysts of the pancreas directly depended on the preoperative findings and, first of all, on the presence of the connection of the cyst with the pancreatic ducts. Favorable conditions for endoscopic correction in the treatment of pancreatic pseudocysts were a small (less than 10 mm) distance between their cavity and the lumen of the gastrointestinal tract, minimal thickness of the capsule (no more than 2 mm), large dimensions (over 6 cm), as well as localization in the projection body and isthmus of the pancreas.
 Research results. When analyzing the results of the treatment of complications of pancreatic necrosis, we formulated an algorithm for the rational choice of operative interventions. We believe that rational treatment is based on early diagnosis of PN complications, including hemorrhagic ones.
 Conclusions. The use of the developed algorithm allowed us to reliably reduce postoperative mortality among patients of this category.