Teslenko M. Prognosis and prophylaxis of complications in surgical treatment of chronic pancreatitis and pancreatic cancer predominantly involving the head of the pancreas.

The author carried out a retrospective and prospective assessment of the results of surgical treatment of 156 patients with chronic pancreatitis and pancreatic cancer predominantly involving the head of the pancreas. The main criteria necessary for preoperative examination have been determined, and an algorithm for diagnosing patients with expansive process in the head of the pancreas, specifically in the presence of mechanical jaundice, has been developed. The study of the activity of oxidant-antioxidant homeostasis and endothelial dysfunction indices indicates a disturbance of oxidation-reduction processes in patients most expressed in those with pancreatic cancer occurring secondary to accumulation of active forms of oxygen and lipid peroxidation products with the formation of structural and metabolic impairments of plasma membranes, triggering entrance of free sulfhydryl groups into the blood and a decrease in the reduction potential of the cell and its synthetic properties. Results of the study of endothelial dysfunction state showed an increase in plasma levels of nitrites, nitrates, S-nitrosothiols, endothelial NO-synthase in all patients, which manifestation rate depended not only on the type of the disorder, but also on the presence of mechanical jaundice. At the same time, the study of inducible NO synthase showed an increase in enzyme activity in chronic pancreatitis and its significant decrease in pancreatic cancer. Studies have shown that VEGF is the most informative indicator for differential diagnosis (chronic pancreatitis - pancreatic cancer). A comparison of the mean values of the indices in these groups revealed a threshold value of VEGF, which averaged 346 pg / ml, which allowed the distribution of these two groups of patients and provide differential diagnosis. Comprehensive morphological study of intraoperatively distant regions of the pancreas has revealed that chronic pancreatitis is characterized by severe structural and functional impairments in the form of vascular dystonia, dystrophy and destruction of their wall and basal membrane with alternative endothelial changes that cause the development of its synthetic hypofunction and disorders of proliferative activity. Damage of the vessels is accompanied by severe discirculatory and destructive changes in pancreatic tissue, and all the samples of tissue surrounding tumor have been found to have a histological picture of chronic pancreatitis with severe stromal fibrosis and significant lymphohistiocytic infiltration, atrophy of the acinar tissue and pseudolobules formation by metaplasia of acinar epithelium with the formation of acinoductular structures, and in a number of cases with focal points of hyperplastic changes in the epithelium of the ducts in the form of intraductal neoplasia predominantly of the third degree (PanIN-3). The findings obtained in the study allowed to elaborate an algorithm for surgical treatment of chronic pancreatitis and pancreatic cancer predominantly involving the head of the pancreas, which made it possible to provide differential approach to determination of the scope and type of surgical intervention, depending on the degree and nature of pathological changes in the gland, as well as the state of adjacent organs and severity of the patient's state, which significantly reduced the number of postoperative complications and mortality ( 2 78.596, p 0.000).