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Khirurgii

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Year 2016 Vol. 24 No 4

GENERAL & SPECIAL SURGERY

N.A. PRONIN, S.V. TARASENKO, A.V. PAVLOV, I.A. SUCHKOV

OPERATIVE TREATMENT OF CHRONIC PANCREATITIS WITH REGARD TO ANATOMICAL FEATURES OF ARTERIAL NETWORK IN THE PANCREATIC HEAD

SBEE HPE "Ryazan State Medical University named after Academician I.P. Pavlov"
Ryazan
The Russian Federation

Objectives. Optimization of the surgical treatment of chronic pancreatitis with the regard to variants of the blood supply of the pancreatic head.
Methods. The study was conducted in two stages. At the 1st stages extraorgan arteries of the pancreas and duodenum were studied by the preparation method of 42 organ complex of the upper level of the abdominal cavity. At the 2nd, clinical stage, the patients were divided into 2 subgroups depending on the operative intervention. In the patients of A group (32 cases) the resection of the pancreatic head with the longitudinal pancreatojejunoanastomosis was performed by modified technique (2003) over standard Frey procedures taking into consideration the changes according to the obtained anatomical findings. The patients of B group (44 cases) were operated on by the Frey classical method (modification of 2003). The comparative retrospective and prospective assessment of treatment outcomes among the patients has been conducted.
Results. The anterior pancreatoduodenal arc has been found out to have several variants of localization in relation to the pancreatoduodenal complex. However, the sources of the arteries, forming the arc, and the sites of their offshoot are characterized by relatively constancy permiting ligation the elements of the anterior arc beyond the pancreatic altered tissues up to the stage of the parenchyma resection. Intraoperative blood loss was less than 400 ml (ð<0,01) in 24 patients in the group A and in 22 patients in the group B (ð<0,01). The early postoperative complications were observed in 18,75% patients in the group A and in 22,7% patients in the group B. In the late postoperative period (6 months after the surgery) the abdominal pain syndrome according to Visual Analogue Scale in 29 patients of the group A was assessed on the level 1-2 (ð<0,01), and in 31 patienrs of the group B the same parameters were registered (ð<0,01).
Conclusion. Combination of the preliminary ligation of the elements of the anterior pancreatoduodenal arterial arc with more radical excision of the scar-altered pancreatic parenchyma allows optimizing the surgical treatment of chronic pancreatitis.

Keywords: chronic pancreatitis, complications, pancreatic arteries, the Frey surgery, abdominal pain syndrome, Visual Analogue Scale, life quality
p. 348-354 of the original issue
References
  1. Egorov VI, Vishnevskij VA, Shastnyj AT, Shevchenko TV, Zhavoronkova OI, Petrov RV, i dr. Rezekcija golovki podzheludochnoj zhelezy pri hronicheskom pankreatite [Resection of the head of the pancreas in chronic pancreatitis]. Khirurgija Zhurn im NI Pirogova. 2009;(8):57-66.
  2. Tarasenko SV, Karjuhin IV, Rahmaev TS, Lun'kov IA, Nikitin DA, Donjukova SP, i dr. Opyt primenenija punkcionno-drenirujushhih vmeshatel'stv s ul'trazvukovoj navigaciej v lechenie pacientov s kistami podzheludochnoj zhelezy pri hronicheskom pankreatite [Experience of puncture-draining interventions with ultrasound navigation in the treatment of patients with pancreatic cysts in chronic pancreatitis]. Ros Med-Biol Vestn im akad IP Pavlova. 2013;(3):124-29.
  3. Kochatkov AV, Kriger AG, Berelavichus SV, Korolev SV, Svitina KA, Kosova IA. Rezekcija golovki podzheludochnoj zhelezy s prodol'nym pankreatikoejunoanastomozom (operacija Freja) [Resection of the pancreatic head with a longitudinal anastomosis pancreatin (Frey's operation)]. Khirurgija Zhurn im NI Pirogova. 2012;(2):31-36.
  4. Lazutkin MV, Ivanusa SJa, Tihomirova OE. Vnutriarterial'nyj regionarnyj infuzionnyj trakt v diagnostike i lechenii ostrogo pankreatita [Intra-regional infusion path in the diagnosis and treatment of acute pancreatitis]. Ros Med-Biol Vestn im akad IP Pavlova. 2014;(3):120-25.
  5. Pronin NA, Pavlov AV. Znachenie variantov krovosnabzhenija pankreatoduodenal'noj oblasti pri operativnom lechenii hronicheskogo pankreatita [The value of blood supply options of pancreatoduodenal area during surgical treatment of chronic pancreatitis]. Ros Med-Biol Vestn im akad IP Pavlova. 2015;(3):27-31.
  6. Kolotushkin IA, Balnykov S, Trohanov MJu. Ocenka vlijanija oktreotida na dinamiku letal'nosti u bol'nyh pankreonekrozom [Assessment of octreotide impact on the dynamics of mortality in patients with pancreatic necrosis]. Nauka molodyh – Eruditio Juvenium. 2014;(4):88-94.
  7. Di Sebastiano P, di Mola FF, Bockman DE, Friess H, Büchler MW. Chronic pancreatitis: the perspective of pain generation by neuroimmune interaction. Gut. 2003 Jun;52(6):907-11.
  8. Emmrich J, Weber I, Nausch M, Sparmann G, Koch K, Seyfarth M, et al. Immunohistochemical characterization of the pancreatic cellular infiltrate in normal pancreas, chronic pancreatitis and pancreatic carcinoma. Digestion. 1998;59(3):192-98.
  9. Bockman DE, Buchler M, Malfertheiner P, Beger HG. Analysis of nerves in chronic pancreatitis. Gastroenterology. 1988 Jun;94(6):1459-69.
  10. Kopchak VM, Usenko AJu, Kopchak KV, Zelinskij AI. Hirurgicheskaja anatomija podzheludochnoj zhelezy [Surgical anatomy of the pancreas]. Kiev, Ukraina: Askanija; 2011. 141 s.
  11. Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas. 1987;2(6):701-7.
  12. Frey CF, Mayer KL. Comparison of local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (Frey procedure) and duodenum-preserving resection of the pancreatic head (Beger procedure). World J Surg. 2003 Nov;27(11):1217-30.
  13. Kolesnikov LL, red. Mezhdunarodnaja anatomicheskaja terminologija (s oficial'nym spiskom russkih jekvivalentov) [International anatomical terminology (on an official list of russian equivalents)]. Moscow. RF; 2003.424 p.
  14. Timerbulatov ShV, Fajazov RR, Smyr RR, Gataullina JeZ, Shakirov RF, Idrisov TS, i dr. Metod opredelenija ob#ema i stepeni krovopoteri [The method of determining of the volume and extent of blood loss]. Klin i Jeksperim Khirurgija. 2012;(5):49-54.
  15. Johson C. Measuring pain. Visual analog scale versus numeric pain scale: what is the difference? J Chiropr Med. 2005 Winter;4(1):43-44. doi: 10/1016/S0899-3467(07)60112-8.
Address for correspondence:
390026, Russian Federation,
Ryazan, Vyisokovoltnaya str. 9,
Medical University RyazGMU Russian Ministry of Health,
chair of cardiovascular, endovascular, operative surgery and topographic anatomy. Tel: 8 9056 91-34-56
E-mail: proninnikolay@mail.ru
Pronin Nikolay Alekseevich
Information about the authors:
Pronin N.A. Assistant, SBEE HPE “Ryazan State Medical University named after Academician I.P.Pavlov”, chair of anatomy.
Tarasenko S.V. MD, Professor, Head, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", chair of hospital surgery, chief physician, SBE RR "City Clinical Emergency Hospital", Ryazan, Director, Center "Surgery of the liver, biliary tracts and pancreas".
Pavlov A.V. MD, Ass. Professor, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", chair of cardiovascular, endovascular, operative surgery and topographic anatomy.
Suchkov I.A. MD, Ass. Professor, Professor, SBEE HPE "Ryazan State Medical University named after Academician I.P.Pavlov", chair of cardiovascular, endovascular, operative surgery and topographic anatomy.
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