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Year 2012 Vol. 20 No 2
GENERAL AND SPECIAL SURGERY
ESTIMATION OF STATE SEVERITY DEGREE OF PATIENTS AND OF EFFICACY OF VARIOUS TREATMENT METHODS AT SUBTOTAL-TOTAL PANCREATONECROSIS
Nefteyugansk city hospital,
The Russian Federation
Objectives. To estimate the possibilities of minimally invasive technologies in treatment of patients with subtotal-total forms of pancreatonecrosis (PN) in early stages of the disease.
Methods. The analysis of 668 patients’ case histories with acute pancreatonecrosis was carried out; the group including 112 (16,7%) patients with subtotal-total forms of pancreatonecrosis was established; the results of their treatment were analyzed. The patients were divided into 3 groups” the 1st group – 39 (34,8%) patients in whom only intensive conservative therapy was applied; the 2nd group – 31 (27,7%) patients in whom minimally invasive technologies (open and half-open methods of treatment) were additionally used during the process of treatment; the 3rd group – 42 (37,5%) patients who were treated using various operative surgical techniques (open method). Severity of patients’ state as well as the course prognosis was evaluated using scales of polyorgan insufficiency MODS, APACHE III before and after used methods of treatment.
Results. In early terms in all patients severe systemic disturbances were noticed together with extensive lesions of the pancreas. The estimation system of severity and prognosis APACHE III permitted to reveal the relation between the degree of polyorgan insufficiency and the degree of expressiveness of the accompanying pathology.
Application of multicomponent intensive conservative therapy and minimally invasive operative interventions allowed getting a favorable result in 67 (95,7%) patients, in all three groups – in 95 (84,8%) patients. The general lethality at subtotal-total pancreatonecrosis in early terms of the disease correlates with the type and volume of treatment; in the group of patients with conservative treatment it made up 5,1%; with application of minimally invasive technologies – 3,2%; with the application of laparotomy – 33,3% correspondently.
Conclusions. Subtotal-total forms of pancreatonecrosis occur in 16,7% patients with the verified acute pancreatitis. APACHE III scale at subtotal-total pancreatonecrosis permits to evaluate the state severity degree and to predict the efficacy of the applied complex therapy. Application of minimally invasive technologies allows decreasing lethality rate at pancreatonecrosis at early terms of the disease.
1. Zatevakhin II, Tsitsiashvili MSh, Budurova MD, Altunin AI. Pankreonekroz (diagnostika, prognozirovanie i lechenie) [Pancreatic necrosis (diagnosis, prognosis and treatment)]. Moscow, RF; 2007. 224 p.
2. Kukosh MV. Ostryi destruktivnyi pankreatit [Acute destructive pancreatitis]. Nizhny Novgorod , NGMA, RF; 2008. 124 p.
3. Nesterenko IuA, Laptev VV, Mikhailusov SV. Diagnostika i lechenie destruktivnogo pankreatita [Diagnosis and treatment of destructive pancreatitis]. 2e izd. Moscow, RF: BINOM-PROGRESS; 2004. 304 p.
4. Balnykov SI, Petrenko TF. Prognozirovanie iskhoda zabolevaniia u bol'nykh nekroticheskim pankreatitom [The prediction of disease outcome in patients with necrotizing pancreatitis]. Khirurgiia. 2010;(3):57–59.
5. Eachempati SR, Hydo LJ, Barie PS. Severite scoring for prognostication in patients with severe acute pancreatitis: comparative analysis of the Ranson score and they APACHE III. Arch Surg. 2002;137:730–36.
6. Lomonosov SP. Ispol'zovanie shkaly APACHE II dlia otsenki tiazhesti sostoianiia bol'nykh s infitsirovannym nekroticheskim pankreatitom [The use of APACHE II score for risk stratification of patients with infected necrotizing pancreatitis]. Ukrain Med Chasopis. 2000;(3):21–25.
7. Gostishchev VK, Glushko VA. Pankreonekroz i ego oslozhneniia, osnovnye printsipy khirurgicheskogo lecheniia [Necrotizing pancreatitis and its complications, the main principles of surgical treatment]. Khirurgiia. 2003;(3):50–54.
8. Savel'ev VS, Filimonov MI, Burnevich SZ. Pankreonekrozy [Pancreatonecrosis] . Moscow, RF; 2008. 264 p.
9. Domingues- Munos JE, Carballo F, GarciaMJ. Evaluation of the clinical usefulness of APACHE II and SARS sestems in the initial prognosticclassification of acutepancreaticus. A multicenter study. Pancreas. 1993;8:6826.
10. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II a severity of disease classification system. Cri Care Med. 1985 Oct;13(10):818–29.
628300, Rossiiskaia Federatsiia, Tiumenskaia obl., Khanty-Mansiiskii avtonomnyi okrug, g. Nefteiugansk, Tsentral'naia gorodskaia bol'nitsa, khirurgicheskoe otdelenie,
Kashevkin Sergei Anatol'evich
Kashevkin S.A., a surgeon of the department of surgery, Nefteyugansk central city hospital.