SURGICAL TREATMENT OF CHRONIC PANCREATITIS: A COMPARATIVE ANALYSIS OF RESULTS AND QUALITY OF LIFE

The aim of the work: to substantiate the nature and scope of surgical intervention in patients with chronic pancreatitis depending on the degree and nature of morpho-structural changes in the pancreatic tissue, and to perform a comparative assessment of the quality of life of the operated patients. Materials and Methods. The research is based on the analysis of treatment results of 147 patients with various forms of chronic pancreatitis who were treated in a general surgical hospital. Of these, 47 (31.9 %) were operated on. Males accounted for 79.8 %, and females – 20.2 %, aged 30–75 years. The diagnostic program included laboratory and instrumental data, such as ultrasound (US); computed tomography (CT); fibrogastroduodenoscopy (FGDS); and endoscopic retrograde cholangiopancreatography (ERCP). Morphological features of fibrotic forms of chronic pancreatitis were studied. To detect exocrine insufficiency, the level of fecal elastase-1 in the stool was determined, and coprological examination was performed. To detect endocrine function, fasting glucose, HbA1c, and C-peptide were measured. The results of surgical treatment were evaluated as good, satisfactory, and unsatisfactory (according to the Vizik-Komorovski method 1992). The Izbicki pain scale was used to assess pain. Functional status was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30). Preoperative management of patients was performed using the Fast Track Surgery technology. Statistical processing of the research results was carried out using biostatistical analysis methods, which were implemented in the licensed software packages Microsoft Office 2010 (Microsoft Excel 2010), and methods of variational statistics, and multivariate correlation analysis. Results. The study results showed that surgical intervention for chronic pancreatitis is recognized as the most effective option for pain control. Our study compares the short-term dynamics of the pain syndrome and quality of life after drainage, combined, and resectional types of surgical interventions. The study systematized the indications for various types of operations depending on the clinical and morphological forms of chronic pancreatitis without a negative impact on the postoperative outcome. Conclusions. A comparative evaluation of surgical interventions for clinical and morphological forms of chronic pancreatitis based on the intensity of the pain syndrome and the assessment of quality of life using the EORTC QLQ-C30 functional scale showed that resectional and combined operations had the best results. The selection of patients for surgical intervention is resolved multidisciplinarily with the involvement of a gastroenterologist, endocrinologist, and anesthesiologist.