Novosti
Khirurgii

MIKHAYLUSOV S.V., MOISEENKOVA E.V., CHERNYAKOV A.V., ESHTREKOV M.S.

SANITATION OF ACUTE FLUID ACCUMULATIONS, COMPLICATING PANCREATONECROSIS COURSE

The sanitation results of acute fluid accumulations (AFA) have been analyzed, complicating the course of pancreatonecrosis (PN) in 142 patients without extended affection of the peritoneal cellular tissue. Fine-needle punctures (FNP) were used in 32 cases, the transdermic puncture drainage (PD) – in 92 cases. 18 patients have been operated on. The main criterion of efficacy of the medical actions was the AFA elimination. The performance of FNP permitted to obtain the given result in 65,6% of observations and appeared to be justified when the volume of nidus was less than 100 ml without sequestration. At the AFA volume more than 100 ml it’s more preferable to use PD, though in 9,8% cases after drainage detritus is infected. In patients over 65 the treatment is more often ineffective. In 34,8% of observations after PD, the presences of pancreatic fistula are confirmed, mainly at -amylase level in the aspirated fluid higher than 1000 units. And only in 6,5% of cases an enteric fistula was revealed. After PD at dense content, its inadequate flow-out and sequestration presence, drainage canal bougieurage with the subsequent endoscopic sequestrectomy improves the effect of sanitation. Less-invasive sanitation of AFA decreases the rate of complications in comparison with open surgeries.

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