FEATURES OF DIAGNOSTIC SURGICAL TREATMENT OF COMPLICATIONS OF NECROTIC PANCREATITIS

Summary. The aim of the study. On the basis of the conducted research, optimize the program of comprehensive diagnosis of complications of necrotic pancreatitis and the principles of surgical treatment of infected pancreatic necrosis. Materials and methods. Analysis of diagnosis and treatment of 496 patients with acute pancreatitis was performed. Necrotic forms of purulent pancreatitis were diagnosed in 178 (35.9%) patients. Clinical, biochemical and bacteriological methods of laboratory diagnostics were carried out upon admission to the hospital and every 2-5 days depending on the severity of their condition. Ultrasound and endoscopic examination were performed for diagnostic and therapeutic purposes. X-ray diagnostic methods were widely used: X-ray of the stomach and duodenum with barium, fistulography, puncture pancreatocystography. Diagnostic scales were used to study the severity of the course of acute pancreatitis and the prognosis of the disease. The obtained data were processed using statistical methods. Results. The use of modified surgical tactics in the treatment of infected forms of pancreatic necrosis made it possible to reduce postoperative mortality to 14.3%. Conclusions. Indications for early surgical interventions in pancreatic necrosis are biliary pathology and the impossibility of excluding other acute pathology from the abdominal organs, as well as the progression of pancreatic necrosis with significant deterioration of the patient’s general condition. The principle of surgical treatment of infected pancreatic necrosis is to perform surgical intervention in relatively late (more than 20 days from the onset of the disease), after suppression of the systemic inflammatory reaction and possible sequestration of necrosis centers. In surgical treatment, the method of completing the operation for necrotic pancreatitis and its purulent-necrotic complications is closed lavage, which is more effective in the treatment of localized forms of purulent-necrotic pancreatitis; the method of programmed relaparotomy - for common forms of purulent complications of intra-abdominal localization and widespread purulent peritonitis; the method of treatment through a «controlled» laparostomy is effective in the treatment of large retroperitoneal phlegmons.