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 ofcomplications of necrotic pancreatitis and the principles of surgicaltreatment of infected pancreatic necrosis.Materials and methods. Analysis of diagnosis and treatment of496 patients with acute pancreatitis was performed. Necrotic formsof purulent pancreatitis were diagnosed in 178 (35.9%) patients.Clinical, biochemical and bacteriological methods of laboratorydiagnostics were carried out upon admission to the hospital and every2-5 days depending on the severity of their condition. Ultrasoundand endoscopic examination were performed for diagnostic andtherapeutic 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 studythe severity of the course of acute pancreatitis and the prognosis of thedisease. The obtained data were processed using statistical methods.Results. The use of modified surgical tactics in the treatment ofinfected forms of pancreatic necrosis made it possible to reducepostoperative mortality to 14.3%.Conclusions. Indications for early surgical interventions inpancreatic necrosis are biliary pathology and the impossibility ofexcluding other acute pathology from the abdominal organs, as wellas the progression of pancreatic necrosis with significant deteriorationof the patient’s general condition.The principle of surgical treatment of infected pancreatic necrosisis to perform surgical intervention in relatively late (more than 20days from the onset of the disease), after suppression of the systemicinflammatory reaction and possible sequestration of necrosis centers.In surgical treatment, the method of completing the operationfor necrotic pancreatitis and its purulent-necrotic complications isclosed lavage, which is more effective in the treatment of localizedforms of purulent-necrotic pancreatitis; the method of programmedrelaparotomy - for common forms of purulent complications of intraabdominallocalization and widespread purulent peritonitis; themethod of treatment through a «controlled» laparostomy is effectivein the treatment of large retroperitoneal phlegmons.