COMPLEX APPROACH TO DIAGNOSTICS AND MANAGEMENT OF INFECTED PANCREATONECROSIS

Aim. To improve the diagnostics and management of patients with infected pancreatonecrosis. Materials and methods. Eighty one patients with infected pancreatonecrosis were treated at the surgical unit of City Clinical Hospital № 21 of the city of Ufa from 2010 to 2015. Complex assessment of the patients’ health status was conducted on the basis of integral scales such as Ranson, Glasgow, BISAP, modified Marshall, APACHE II, APACHE III, APACHE IV, MEWS, CTSI, EPIC, HAPS. Infected pancreatonecrosis was diagnosed on the basis of procalcitonin, C-reactive protein, lipopolysacharide of gram-negative bacteria levels, CT with bolus contrast. Laparoscopic surgery with retroperitoneoscopic sanations of retroperitoneal cellular tissue with phlegmon available was performed. Besides, assisted sequestrnecrectomies with handport inserted into the left hypochondrium and formation of omentoburstoma were carried out. Results. A mean period of staying at the hospital was 80 ± 3,7 days; lethality - 27,3 %. External pancreatic was formed in 21,8 %. Pancreatic pseudocysts were formed in 20 %. Conclusions. This algorithm permitted to diagnose infected pancreatonecrosis. Mini-invasive techniques allowed to reduce mortality and quantity of the postoperative complications.

Acute pancreatitis, infected pancreatonecrosis, mini-invasive techniques, retroperitoneoscopic sanations, lipopolysacharide of gram-negative bacteria