Relevance. The article is devoted to the problem of diagnosis and treatment of acute biliary pancreatitis, which remains one of the most common surgical diseases of the abdominal cavity and accounts for 33.2% of the total number of patients with acute pancreatitis.
Objective of the work is to improve the diagnosis and results of surgical treatment of patients with acute pancreatitis of biliary etiology.
Materials and methods. The results of treatment of 264 patients with acute pancreatitis of biliary etiology are analyzed. Operative treatment was applied in 92 (34,8 %) patients: endoscopic operations were performed in 44 patients (16,7 %). Thus, in 10 (3,8 %) patients, endoscopic papilloprotectomy was performed with the auditory of the duct system and the extraction of concrements. In other cases, organo-preserving intervention was performed without disturbing the morphofunctional integrity of the sphincter apparatus of the duct system: the cannulation in 6 (2,3%) patients, mechanical (balloon) in 5 (1,9 %) cases, pharmacological (myogenic antispasmodic) dilatation of distal duct and a large duodenal papilla in 11 (4,2 %) patients. In residual choledocholithiasis, a technique of papillotomy under the control of choledochoscopy was proposed – 12 (4,54 %) patients. A comparative analysis of the effectiveness of the treatment of patients who used the "open" (comparative group) and noninvasive endoscopic interventions in the early disease (the main group) was performed.
Results. So in the main group the length of stay in the hospital was 12±3,2 days, respectively, in the comparison group – 26±4,3 days. In 42 (95,4 %) patients who had undergone endoscopic surgery, a positive clinical effect, a rapid regress of the symptoms of acute pancreatitis was achieved. In two (4,5 %) patients in the main group, the course was complicated by the development of the abscess of the stuffing box, and puncture under ultrasound control was performed. In patients of the comparison group complications arose in 5 (41,6 %) patients, it is noteworthy that all of them had undergone operative interventions, which were limited only to the rehabilitation and drainage of the abdominal cavity, a stuffing box bag. The mortality rate among unopposed was 1,2 % (2 patients), and among the operated – 11,9 % (11 patients). Among prooperated patients who died, 81,8 % (9 people) were elderly patients.
Conclusions. The use of minimally invasive endoscopic interventions in the early phase of the disease reduces the length of stay of patients in the hospital from 26±4,3 days (comparison group) to 12 3,2 days (main group) and the number of complications occurring by 37,1 % (P <0, 05). Application of the proposed method of papillotomy under the control of choledochoscopy makes it possible to reduce the risk of perforation of the wall of the duodenum with the development of peritonitis or retroperitoneal phlegmon by 1,2 % (P <0,05).
Avakimyan S.V. Prognoz i taktika lecheniya ostrogo pankreatita v zavisimosti ot tyazhesti patologicheskogo protsessa. Dis. … dok. med. nauk [The prognosis and tactics of treatment of acute pancreatitis, depending on the severity of the pathological process] / Krasnodar, 2015. 284 p.] [in Russian]
Balalyikin A.S. Endoskopicheskaya abdominalnaya hirurgiya [Endoscopic Abdominal Surgery] / Moscow, 1996. P. 36. [in Russian]
Vasilev Yu.V. Endoskopicheskaya pankreatoholangiografiya v diagnostike porazheniy podzheludochnoy zhelezyi, vne- i vnutripechYonochnyih zhYolchnyih protokov [Endoscopic cholangiopancreatography in the diagnosis of lesions of the pancreas, intra-and intrahepatic bile ducts] // Rus. journals gastroenterology, hepatology, coloproctology. 1999. Vol. 8, No. 3. P. 18-23. [in Russian]
Gostriy pankreatit / Adaptovana klinichna nastanova, zasnovana na dokazah / pid red M.P. Komarov ta in. [Gostriy pancreatitis. Adapted as a klіnіchna nastanova, based on proofs / under the editorship of M.P. Mosquitoes] // Kyiv: "The State Expert Center of the Ministry of Health of Ukraine". 2016. 53 p. [in Ukrainian]
Bahr M.H., Davis B.R., Vitale G.C. Endoscopic management of acute pancreatitis // Surg. Clin. North Amer. 2013. Vol. 93, No. 3. P. 563-584. DOI: 10.1016/j.suc.2013.02.009
Bosetti C., Bravi F., Turati F. et al. Nutrient-based dietary patterns and pancreatic cancer risk // Ann. Epidemiol. 2013. Vol. 23, No. 3. P. 124-128. DOI: 10.1016/j.annepidem.2012.12.005
Dellinger E. P., Forsmark C. E., Layer P. et al. Determinant based classification of acute pancreatitis severity: an international multidisciplinary consultation // Ann. Surg. 2012. Vol. 254, No. 6. P. 875-880. DOI: 10.1097/SLA.0b013e318256f778
Cote G.A., Yadav D., Slivka A. et al. Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis // Clin. Gastroenterol. Hepatol. 2011. Vol. 9, No. 3. P. 266-273. DOI: 10.1016/j.cgh.2010.10.015
Khan J., Solakivi T., Seppänen H.et al. Serum lipid and fatty acid profiles are highly changed in patients with alcohol induced acute pancreatitis // Pancreatology. 2012. Vol. 12, No. 1. P. 44-48. DOI: 10.1016/j.pan.2011.12.006
Larson S.D., Nealon W.H., Evers B.M. Management of gallstone pancreatitis // Adv. Surg. 2006. Vol. 40. P. 265-284. PMID: 17163108
Meyer A., Coffey M.J., Oliver M.R. et al. Contrast and comparisons between childhood and adult onset acute pancreatitis // Pancreatology. 2013. Vol.13, No. 4. P. 429-435. DOI: 10.1016/j.pan.2013.06.005
Pezzilli R. Etiology of chronic pancreatitis: Has it changed in the last decade?// World J. Gastroenterology. 2009. Vol. 15, No. 38. P. 4737-4740. DOI: 10.3748/wjg.15.4737
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