Паёми Сино (Sep 2017)
POSSIBILITIES OF SURGICAL TREATMENT OF PATIENTS WITH ACUTE PANCREATITIS OF THE HEAVY DEGREE IN CONDITIONS OF SPECIALIZED DEPARTMENT OF REGIONAL CLINICAL HOSPITAL
Abstract
Objective: To analyze the results of treatment of patients with acute pancreatitis of the heavy degree (APHD) in the conditions of a specialized department of the regional clinical hospital. Methods: The results of diagnostics and treatment of 1230 patients of APHD in the Department of Purulent Surgery (DPS) are presented. In accordance with the routing of patients, the APHD was provided, the first phase of the disease in the intensive care units of inter-district centers was financed and methodically provided. After arresting the phenomena of pancreatogenic shock and the appearance of infections, the patients were transferred to the Sverdlovsk Regional Clinical Hospital № 1. Results: Infected peripancreatic infiltrates occurred in 173 patients. In 23 patients, an attempt of draining way was through the surgical separation of the infiltrate. Mortality rate was 52.2%. One hundred thirty nine patients were treated only conservatively, lethality was 5.8%. Pancreatogenic abscesses occurred in 221 patients, they were given navigational punctures with the aspiration of the contents, puncture drainage and drainage from the mini-accesses. Unopened variants of pancreatogenic septic sequestration of retroperitoneal tissue were detected in 836 patients. These patients were operated without using wide incisions. Mortality in this group was 24.5%. Patients of APHD in the phase of unlimited septic sequestration are given pre-treatment for the terminal drainage, which is possible at the place of occurrence of the case. The primary operation was performed in the zone of the greatest change in the retroperitoneal space, in most cases through the omentobursostomy. The remaining foci of unlimited septic sequestration were drained after stabilization of the state in the conditions of a specialized department. Conclusion: Regional routing of patients with APHD made it possible to effectively use the capabilities of surgical hospitals of different levels when providing assistance to patients with APHD. Patients with acute pancreatitis of the heavy degree in the phase of unlimited septic sequestration should be given a gradual drainage, which is possible in the place of occurrence of the case. The primary operation can be performed in the zone of the greatest changes in the retroperitoneal space (in most cases) through the omentobursostomy at the stage of surgical care. The remaining foci of unlimited septic sequestration can be drained after stabilization of the condition in the conditions of a specialized department.
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