A.M. ZAYNUTDINOV^1,2, I.S. MALKOV¹

¹Kazan State Medical Academy, 36 Butlerov St., Kazan, Russian Federation, 420012

²Republican clinical hospital № 2, 1a Chekhov St., Kazan, Russian Federation, 420000

³Municipal Clinical Hospital № 7, 54 Chuykov St., Kazan, Russian Federation, 420103

Zaynutdinov A.M. — Cand. Med. Sc., Associate Professor of the Surgery Department, Head of Surgery Division, tel. +7-917-268-25-34, e-mail: zainoutdinov@mail.ru^1,2

Malkov I.S. — D. Med. Sc., Professor, Head of the Surgery Department, tel. +7-965-594-40-07, e-mail: ismalkov@yahoo.com^1,3

The article gives a short overview of the optimal treatment method of acute pancreatitis. In the first period (1987-1993), when an active surgical approach was used, there were operated 102 patients. Operations were made mainly in the first week of the disease, at an aseptic stage. For 27 patients (26.5%) was made the corpora-caudal partial pancreatectomy with splenectomy. Herewith, postoperative lethality amounted to 37,2%. In the second period (1994-2001) were operated 256 patients. All operations were of the drainage nature and were performed on different dates from the beginning of the disease. Postoperative mortality was 17.3%. Since 2002, the hospital adheres to the active-watchful waiting when alternative of the «early» surgical interventions is the therapeutic manipulation under control of laparoscopy or ultrasound, which reduced the overall postoperative mortality to 13.4%. In case of pancreatitis of medium severity it was possible to lower severity to 5%, heavy severity — to 26%.

Key words: acute pancreatitis, laparotomy, laparoscopy, manipulations under ultrasound control.

 

 

 

REFERENCES

1. Beburishvili A.G., Burchuladze N.Sh., Mandrikov V.V. Etapnoe lechenie ostrogo pankreatita i ego iskhodov [Staged treatment of acute pancreatitis and its outcomes]. 9-y vserossiyskiy s»ezd khirurgov, 1999. Pp. 15-16.

2. Vinnik Yu.S., Cherdantsev D.V., Miller S.V., Pervova O.V., Miller M.S. Vliyanie sposoba operativnogo vmeshatel’stva na sindrom sistemnoy vospalitel’noy reaktsii pri pankreonekroze [Influence of the method of surgical intervention on the systemic inflammatory response syndrome in necrotizing pancreatitis]. Mezhdunarodnyy khirurgicheskiy kongress, 2003. P. 31.

3. Gal’perin E.I., Dyuzheva T.G., Dokuchaev K.V. Minimal’no invazivnye vmeshatel’stva na sal’nikovoy sumke i zabryushinnoy kletchatke v profilaktike i lechenii infitsirovannogo pankreonekroza [Minimally invasive interventions in omental and retroperitoneal fat in the prevention and treatment of infected pancreatic necrosis]. Mezhdunarodnyy khirurgicheskiy kongress, 2003. P. 56.

4. Savel’ev V.S., Filimonov M.I., Gel’fand B.R., Burnevich S.Z. Destruktivnyy pankreatit: algoritm diagnostiki i lecheniya (Proekt sostavlen po materialam IX Vserossiyskogo s»ezda khirurgov, sostoyavshegosya 20-22 sentyabrya 2000 g. v Volgograde) [Destructive pancreatitis: an algorithm for diagnosis and treatment (The project is based on materials IX All-Russian Congress of Surgeons, held September 20-22, 2000 in Volgograd)]. Consilium Medicum, 2000, vol. 2, no. 6.

5. Beger H.G., Rau B., Mayer J., Pralle U. Natural course of acute pancreatitis. World J Surg., 1997, vol. 21 (3), pp. 130-135.

6. Beger H.G., Isenmann R. Surgical manangement of necrotizing pancreatitis. Surg. Clin. N. Amer., 1999, vol. 79, no. 4, pp. 793-800.

7. Isenmann R., Schwarz M., Rau B., Trautmann M., Schober W., Beger H.G. Characteristics of infection with Candida species in patients with necrotizing pancreatitis. World J Surg., 2002, vol. 26, pp. 372-376.

8. Frey C.F., Brandley E.L., Beger H.G. Progress in acute pancreatitis. Surg. Gynecol. Obstet., 1988, vol. 167, pp. 282-288.

9. Freeny P.C., Hauptmann E., Althaus S.J. et al. Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: Techniques and results. Amer. J. of Roentgenology, 1998, vol. 170, pp. 969-975.

10. Lee M.J., Wittich G.R., Mueller P.R. Percutaneous intervention in acute pancreatitis. Radiographics, 1998, vol. 18, pp. 711-724.

11. Carter C.R., McKay C.J., Imrie C.W. Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis: An initial experience. Ann. of Surg., 2000, vol. 232, pp. 175-180.

12. Grzebieniak Z., Woyton M., Kielan W. Surgical and endoscopic treatment of pancreatic pseudocysts. Przegl. Lek., 2000, vol. 57 (Suppl 5), pp. 50-52.

13. Cuschieri A. Pancreatic necrosis: pathogenesis and endoscopic management. Semin. Laparosc. Surg., 2002, Mar., vol. 9, pp. 54-63.

14. Hamad G.G., Broderick T.J. Laparoscopic pancreatic necrosectomy. J. Laparoendosc. Adv. Surg. Tech., 2000, vol. 10, pp. 115-118.

15. Baron T.H., Thaggard W.G., Morgan D.E. et al. Endoscopic therapy for organised pancreatic necrosis. Gastroenterology, 1996, vol. 111, pp. 755-764.

16. Malkov I.S., Shaymardanov R.Sh. Ostryy pankreatit [Acute pancreatitis]. Kazan, 2001. P. 60.

17. Malkov I.S., Alukaev M.I., Zaynutdinov A.M., Sharafislamov I.F., Kirshin A.P. Sposob diagnostiki patologii organov bryushnoy polosti i zabryushinnogo prostranstva [A method of diagnosing pathology of the abdominal cavity and retroperitoneal space]. Polozhitel’noe reshenie o vydache patenta na izobretenie RF no. 2003120741/021929 ot 07.07.2003.