Matveiev R. Efferent and mininal invasive techniques in the treatment of patients with destructive forms of acute pancreatitis

The aim of the dissertation is to improve patient treatment with acute necrotizing pancreatitis by improving treatment algorithm. The new technique uses plasmapheresis multiplicity at different stages of the disease. A comprehensive examination and treatment (using plasmapheresis) 164 patients with acute moderate and severe necrotizing pancreatitis. Using conventional methods of plasmapheresis in the early phase reduced leukocyte index of intoxication on the seventh day to 34,86 ± 1,27 %. Noted higher average values for APTT 47,7 ± 2,1 %, decrease in total protein 4,35 ± 0,02 g / l and decreased total calcium in plasma at 10,45 ± 0,38 %. The proposed method provides a similar decrease leukocyte index of intoxication from the first to the seventh day; associated with a significantly less influencing APTT 18,3 ± 1,2 % to 47,7 ± 2,1 %; minimally loss of total protein and total blood calcium, significant decrease in citrate reactions and bleeding. Its use in the early phase of the disease is also associated with shorter duration of dynamic ileus, parenteral nutrition, the frequency of erosive gastro-intestinal bleeding, citrate reactions, the incidence of acute fluid accumulations located parapankreatyc and extraperitoneal, and their total number (all p <0.05 ) and a lower mortality rate 6.8 % against 12,5 % (p> 0,05). Applications developed technique of plasmapheresis in the disease of late phases allowed to postpone surgery on each of the steps and reduce the overall mortality rate to 12.9 % versus 31.3 % (p=0.019).