Krykun M. Diagnosis and prognosis of local complications in the complex treatment of necrotic pancreatitis.

Object of research: local complications of acute pancreatitis. Subject of study: treatment of patient with acute pancreatitis, taking into account the nature of its local complications, the terms of their formation and clinical manifestations. The aim of the study: improvement of the results of treatment of patients with necrotic pancreatitis by timely detection of local complications and optimization of surgical tactics based on the study of additional possibilities of laboratory and immunological diagnostics and prediction of local complications of necrotic pancreatitis. Research methods: general clinical (ultrasound diagnostic of the abdominal cavity, CT examination of the abdominal cavity and retroperitoneum, laboratory methods (blood alpha amylase, biochemical parameters of blood), methods of statictical processing of the obtaned data and their statistical analysis - non-parametric T-criteria Wilkoxon, correlation analysis by r-criteria Spearman, immunoassay analysis. Scientific novelty of the research: on the basis of the comparative analysis of clinical, laboratory, instrumental and some immunological parameters in the groups of patients with acute pancreatitis according to the Atlanta 2012 classification, diagnostic possibilities of intra- and peripancreatic complications based on lymphocytes level were determined. For the first time it has been establisched that to achieve this goal an assessment of the level of lymphocytes can be used, which allows, in addition to diagnosis, to predict the development of complications before their occurrence. The method for predicting the development of local complications of necrotic pancreatitis by determining the level of blood lymphocytes was developed. The comprehesive evaluation of clinical, laboratory and CT manifestations of acute psncreatitis has allowed to identify and construct diagnostic "pairs", which allow to improve the sensivity and reliability of diagnosis of local complications of acute pancreatitis to 96,1%. For the first time the ability to predict local complications of acute pancreatitisby identifying IgG subclasses, as well as determination of these indicators of infection of necrotic collections was identified. The result of the research was the ability to optimise the treatment tactics of acute pancreatitis in the direction of expending the possibilities of conservative treatment and the use of minimally invasive interventions.