Rosenko O. Optimization of Draining Operations Methods in Pancreatonecrosis

The object is pancreatonecrosis; the goal is to improve the surgical therapy results in patients with pancreatonecrosis by developing the diagnostics algorithm of pancreas lesions volume, by determination of optimal term of operative interventions and choice of the most effective methods of draining operations; the methods are general clinical, clinicolaboratory, biochemical, laparoscopic, endoscopic, instrumental, sectional, statistic; the novelty lays in the ascertained evolution regularity of the pathological process according to the pancreas lesions volume. For the first time there were determined and substantiated from the scientific point of view criteria of efficacy assessment of pancreatonecrosis treatment by the use of intraperitoneal pressure (IPP) monitoring and integral scales. There were implemented the usage of intraperitoneal pressure rates and intoxication indices in the complex assessment of acute pancreatitis (AP) course. The role and the diagnostic value of prognostic rates were determined and substantiated from the scientific point of view as well as the implementation reasonability of the different draining methods of pancreatonecrosis foci in the complex treatment of patients with AP depending on the pathologic changes volume in the pancreas and the severity grade of multiple organ failure. The results include the implementation of the received research results that allowed to improve the treatment efficacy of patients with pancreatonecrosis by reducing the quantity of purulent and septic pancreatonecrosis complications from 20,4% to 11,3% in microfocal pancreatonecrosis (MFP) and from 93,3% to 55,8% in large-focal pancreatonecrosis (LFP), and also the lethality rates from 26,7 to 11,5% in LFP and from 47,1 to 21,1% in subtotal-total pancreatonecrosis; it is inculcated - in medical practice, in an educational process; sphere - medical practice.