Chronic pancreatitis is a recurrent progressive disease accompanied by fibrosis and fibrocystic degeneration of the pancreatic parenchyma. There are remained the unexplored issues of progression of fibrosis in the pancreas parenchyma, which lead to a rapid enlargement of the head, the development of complications that require a resection surgery. To develop a differentiated approach to the choice of surgical treatments and indications for pancreatoduodenal resection in complicated forms of chronic pancreatitis, a study was performed in 137 patients underwent resection and drainage surgery. Pancreatoduodenal resection was accomplished in 12 patients. Instrumental research methods were used: multidetector (64−slice) computed tomography with 3D reconstruction, magnetic resonance imaging, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography. Two clinical examples are given. Indications for pancreatoduodenal resection in patients with chronic pancreatitis were expressed fibro−inflammatory process in the area of the pancreas head, suspected development of oncological pathology. Progressive fibrotic changes in the pancreas parenchyma, mainly in the head, occurring in some patients, associated with stellate cell activation and fibrogenesis, they lead to the development of biliary and portal hypertension, stimulation of oncogenesis. It is concluded that with the progression of fibro−inflammatory process in the pancreas head with the development of complications (pancreatic, biliary and portal hypertension), as well as in case of impossibility to exclude the tumor, the surgery of choice is pancreatoduodenal resection. The presence of severe fibrosis in the pancreas parenchyma reduces the risk of developing pancreatic fistula when performing pancreatoduodenal resection. Key words: complicated forms of chronic pancreatitis, pancreatoduodenal resection, fibro−inflammatory process, pancreatic fistula
Purposeof thestudy. Development ofindications for performing pancreatoduodenal resection in complicated forms of chronic pancreatitis. Materials and methods. In chronic pancreatitis, resection and drainage surgical interentions were performed in 142 patients. Pancreatoduodenal resection was performed in 13 patients with complicated forms of chronic pancreatitis. To assess the degree of pancreatic fibrosis, ultrasound elastography was used (in mode Shear Wave Elastography). The indications for pancreatoduodenal resection were the presence of a pronounced fibroinflammatory process in the head of the pancreas, the impossibility of excluding the development of an oncological process, developed complications (biliary hypertension, portal hypertension, duodenal stasis, Results. Among 13 patients with complicated forms of chronic pancreatitis, who underwent pancreatoduodenal resection, 12 (92,3%) patients had severe fibrosis, 1 (7,7%) had minor manifestations of fibrosis. Pancreatoduodenal resection was performed in 2 (15,4%) patients after preliminary biliary decompression, in 2 (15,4%) – after Pjustov-Frey surgery and cystojejunostomy. Conclusion. Progression of fibroinflammatory changes in the pancreatic parenchyma in chronic pancreatitis, leading to the development of complications (biliary hypertension, duodenal stasis), is an indication for the use of resection surgery.
Purpose of the study. Develop an algorithm for the diagnosis and treatment of purulent-septic complications of severe necrotizing forms of acute pancreatitis. Materials and methods. 5400 patients with acute pancreatitis were treated. To determine the infected pancreatic necrosis, the blood calcium level, and blood procalcitonin were studied, and a fine-needle biopsy was performed. Surgical interventions were performed in 874 (16,2%) patients who underwent 1057 surgical interventions. Results. 782 minimally invasive interventions were performed in 645 patients: video laparoscopic – 608 (77,7%), puncture-draining (under ultrasound control) – 102 (13,0%), endoscopic – 38 (4,9%). The following purulent-septic complications of severe forms of acute pancreatitis were revealed: infected pancreatic necrosis in 189 (17,9%), infected peripancreonecrosis in 167 (15,8%), infected pseudocyst in 109 (12,5%) patients. 173 (19,8%) single-stage operative interventions were performed, 56 (6,4%) open-stage multistage patients were performed, and extended necrsequestrectomy was performed. Among minimally invasive interventions, minilaparotomy and lumbotomy were performed in 34 (4,3%). Conclusion. The use of monitoring laboratory and instrumental methods of research in the diagnosis of severe forms of acute pancreatitis and its complications allows you to determine in time the degree and volume of necrotic lesions of the pancreas and develop surgical tactics. Keywords: acute pancreatitis, pancreatonecrosis,purulent-septic complications.
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