SURGICAL TACTICS IN THE TREATMENT OF NECROTIC PANCREATITIS
Introduction. Necrotic pancreatitis is one of the severest abdominal diseases, which is characterized by the pancreatic perfusion disorder of different degree and demands differentiated approach for the patients surgical treatment.
Маterials and methods. Results of treatment of 66 patients, to whom the laparotomy interventions for necrotic pancreatitis were performed, using elaborated own approaches, based on the pancreatic tissue vitality estimation, were analyzed. Indications for pancreatic resection, methods of purulent accumulations drainage and the operative procedures concluding were elaborated.
Results. There was established, that in necrosis over 50% оf pancreatic volume and sepsis it is mandatory to perform total pancreatectomy to remove the infection origin, using wide retroperitoneal drainage and to conclude the operation to perform further ”planned” relaparotomy.
Discussion. Even in modern conditions, when objective estimation of pancreatic perfusion and the necrotic parapancreatic cellular tissue volume are possible in accordance to CT data and the septic state estimation scales, the issues of direct pancreatic resection application and methods of the operations conclusion still are not elaborated.
Conclusion. It is possible to reduce lethality after open operations for necrotic pancreatitis if early diagnosis is accomplished before irreversible pancreatic necrotic changes occur in accordance to radiological investigations (USG, CТ) data and due to the operative intervention volume optimization.
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