Lyubenko D. Prediction, prevention and treatment of an acute postoperative pancreatitis after rentgenendoscopic interventions.

The thesis is devoted to the development of prognostic algorithm for creating and improvement of existing schemes of prevention and treatment of acute postoperative pancreatitis (APP) after rentgenendoscopic interventions (REI). In 50 rats using canaliculus-hipertension model of acute pancreatitis is proved that the prophylactic administration of famotidine - H2-blocker of histamine receptors, combinated with octreotyde-synthetic analogue of somatostatin was resulted in increased the life expectancy of rats by twice. Morphological study of pancreas in rats confirmed the effectiveness of the use of a combination of famotidine and octreotyde for prevention the development of pancreatitis. Clinical studies on 636 patients showed that laboratory indices in the preoperative period can not serve as a prognostic marker of risk of APP after REI. Step by step method of discriminant analysis determined major risk factors for APP after REI: young age (21-35 years) in female patients, multiple attempts of catheterization of large duodenal papilla, mechanical lithotripsy and litoextraction accompanied by multiple revisions; essential hypertension; acute pancreatitis in history. The method of canonical analysis assessed risk factors of APP and obtained coefficients for constructing a canonical function in the form of linear discriminant function equation that allows analysis of each patient and to assign a risk group. The sensitivity of the developed predictive algorithm of APP after REI is 85.3%. Improving preventive therapeutic measures are used along with a complex of traditional treatment in combination with H2-blockers and somatostatin receptor agonists. Application of the developed prediction method and the proposed set of preventive therapeutic measures reduced the frequency of APP in patients after REI in half, and postoperative mortality for 28%.