Cherkun O. Differentiated surgical tactics for parapancreatic infectious-septic complications of destructive pancreatitis.

The dissertation is devoted to studying the problem of infectious and septic complications in patients with destructive forms of acute pancreatitis, and improving the results of their treatment by developing an algorithm for differentiated surgical tactics. The dependence of the duration and severity of organ or multi-organ dysfunction on the prevalence of local parapancreatic purulent-septic complications in patients with severe acute pancreatitis was revealed based on the analysis of data from clinical, laboratory, instrumental studies, as well as lowT3 syndrome. An algorithm of differentiated surgical tactics was developed in patients with purulent-septic complications of acute severe pancreatitis, which takes into account the severity of the patient, the presence of organ/multi-organ dysfunction, taking into account the development of low T3 syndrome, the prevalence, localization and nature (liquid component/sequesters) of local parapancreatic complications. All patients in subgroup 2b of the main group underwent puncture of fluid accumulations for decompression. Drainage under ultrasound control was performed in 22.7% of patients who had pus detected by the results of fine needle puncture. At the same time, in 14.6% of cases, drainage was performed through adjacent zones of parapancreatic necrosis with a single drainage from the flank access, which later allowed to avoid open NSE. After reducing the drainage discharge to 30 ml / day, and after detecting sequestral masses, these patients underwent augmentation of the abscess cavity with the removal of free-lying sequesters. Poledrenage was shown a 4.5% patients, which was the final step in their treatment. After puncture/drainage of parapancreatic fluid accumulations, signs of compression of the upper gastrointestinal tract were observed in 35.3% of patients, signs of SIRS in 13.0%. Patients were shown to determine the level of thyroid hormones and conduct an MRI to determine x-ray-non-contrasted sequestral masses. After further examination, 13.6% of patients underwent urgent surgery - open NSE. The application of the developed algorithm of differentiated surgical tactics using the developed device for augmentation of the abscess cavity through mini-accesses allowed to increase the effectiveness of treatment by reducing the frequency of repeated operations by 5.1%, reducing postoperative complications by 4.4% and the mortality rate by 13.0 %.