Мета. Розроблення лікувально–діагностичної тактики при рідинно–кістозних утвореннях підшлункової залози. Матеріали і методи. Дослідження проведено щодо 48 хворих з гострим деструктивним панкреатитом, ускладненим рідинно–кістозними утвореннями. З діагностичною метою виконували пункцію під контролем ультразвукового дослі- дження з подальшим мікробіологічним та морфологічним дослідженням отриманого аспірату. Результати. Вибір методики залежить від ефективності втручання, яка ґрунтується на вивченні ультразвукової карти- ни досліджуваної зони до та під час втручання, а також у ході динамічного дослідження після операції. Висновки. Використовуючи в комплексній діагностиці морфологічний метод дослідження, можливо в ранні строки диференціювати рідинно–кістозні утворення як ускладнення гострого деструктивного панкреатиту та визначити лі- кувальну тактику.
Summary. Introduction. The search for objective methods for diagnosing the form and severity of acute pancreatitis, accurate prediction and timely prevention of infectious complications in this surgical pathology is of great practical importance for modern medicine. Materials and methods. According to clinical, morphological and bacteriological data, groups of patients were selected. The first group included 33 patients with sterile pancreatic necrosis (SP), the second group consisted of 29 patients with infected pancreatic necrosis (IP). Results and discussion. The program of differential diagnosis of sterile and infected pancreatic necrosis with calculation of the index of differential diagnosis (IDD) for each clinical-laboratory and instrumental indicator used in this system is developed. The development and evaluation of diagnostic possibilities of the method of verification of purulent-septic complications of acute pancreatitis and the transition of a sterile form of pancreatic necrosis to an infected one was carried out. Conclusions. The use of the developed method of diagnosis of sterile and infected pancreatic necrosis with the calculation of the index of differential diagnosis allowed in 93% of cases to distinguish sterile pancreatic necrosis from infected and timely determine the scope and tactics of treatment.
Summary. Purpose. Study of the effectiveness of permanent transmembrane peritoneal dialysis in “semi-closed” management of the abdominal cavity (BP) in patients with advanced purulent peritonitis (APP). Materials and methods. The results of treatment of 63 patients with APP with “semi-closed” administration in the abdominal cavity (BP) were analyzed. Depending on the features of BP drainage, patients with RGP were divided into two groups: comparison group (CG) — 31 patients who used traditional methods of abdominal drainage and the main group (MG) — 32 patients who underwent permanent peritoneal surgery in the postoperative period. dialysis through an artificial semipermeable membrane. Results and discussion. A study of the relationship between the levels of molecules of average weight in spent dialysis solution with the severity of multiorgan failure (MF) on the SOFA scale using Spearman’s correlation analysis revealed an average degree of correlation: 1 day after surgery - r = 0.63 (p = 0.01), for 3 days — r = 0.75 (p = 0.001). The average degree of correlation between these indicators can be explained by the fact that in addition to endotoxicosis, the severity of MF in the next day after surgery also affects surgery. This is also confirmed by the increase in the correlation coefficient by 3 days, when the degree of influence of the operating aid on the severity of MF decreases. The postoperative period was complicated in 14 (22.2 ± 5.2 %) patients with APP: in CG in 10 (32.3 ± 8.4 %) cases in MG - in 4 (12.5 ± 5.8 %) p = 0.059). Mortality of patients with APP at “semi-closed” management of an abdominal cavity made 19,0 ± 4,9 %: in MG — (25,8 ± 7,9) %, in MG — (12,5 ± 5,8) % (p = 0,179). Conclusions. The proposed method of peritoneal dialysis reduced the absolute risk of postoperative complications in patients with advanced purulent peritonitis by 19.8 %.
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