Novokhatny P. Diagnostic and miniinvasive methods of acute pancreatitis treatment

The thesis deals with the improvement of outcomes of acute pancreatitis patients treatment with the help of a comprehensive program developed on the basis of the diagnosis results of various forms of acute pancreatitis and the use of miniinvasive methods of surgical interventions. The work is based on the results of the examination and treatment of 113 patients with various forms of acute pancreatitis. Control group (44 patients) included patients subjected to laparotomy for acute pancreatitis. In the main group 69 patients with acute pancreatitis were treated. The kind of miniinvasive intervention and the principle of selection of the method were defined on the basis of the results. New ways of the treatment of acute pancreatitis are developed which allows to interrupt a pain syndrome or to reduce its intensity, to decrease frequency of operations in patients with parapancreatic infiltrate. Indications for medical laparoscopy, intervention sonography, laparotomies from miniaccess and a wide laparotomy depending on a phase and local complications of acute pancreatitis are defined. Use of the created mathematical forecast models of acute pancreatitis course allows to allocate a contingent of patients with the raised risk of a lethal outcome. In treatment of such patients the well-founded program of complex use of laparoscopic interventions and interventional sonography was applied that gave the possibility to decrease an expected lethality. Through the introduction of less traumatic intervention in acute pancreatitis the mortality rate decreased from 29.5 % to 10.1 %, the number of complications decreased from 52.3 % to 27.5 %.