Naboichenko Y. Surgical treatment of patients with pancreatic pseudocysts using laser vaporization.

The dissertation is devoted to the problem of studying the results of surgical treatment of pseudocysts of the pancreas (PСP), obtained through the use of developed diagnostic and surgical tactics based on new modern technologies. Based on a comprehensive clinical study and analysis of causal factors of different types of acute and chronic pancreatitis, a number of etiopathogenetic areas of diagnosis and surgical treatment of patients with PСP have been proposed. The peculiarities of the clinical picture in patients with PСP have been identified, as well as the changes in biochemical homeostasis that are characteristic of the early period of PСP have been specified. A method of treating pseudocysts of the pancreas using modern laser technologies has been developed and implemented in the clinic. According to the results of the study, a scale of clinical diagnosis was created, which allows to objectify the diagnosis of pseudocysts of the software and predict its outcome by scoring the early signs of software dysfunction. A minimally invasive method of laser vaporization (LV) pseudocyst with a previous ultrasound scan, which performs the intervention in the first hours after admission to the clinic, allows to detect the exact volume of fluid in the cavity and make an informed decision about further surgical tactics. Carrying out of early minimally invasive intervention gives the chance to confirm existence of PСP, postpancreatic complications, to carry out their laser correction, and also to carry out prevention of the possible complications which do not aggravate at the same time a condition of the patient. The use in the clinic of early minimally invasive interventions can significantly reduce the duration of the hospital stage of treatment and achieve satisfactory functional results in the early postoperative period. The paper presents a system for predicting results, which allows to identify and systematize such patients by clinical groups with the same type of tactical tasks and allows to apply a differentiated approach to surgical treatment of different types of pseudocysts. These provisions are of great scientific importance in determining the prognosis and potential risk of adverse effects in patients with PСP. A standardized algorithm of medical and diagnostic tactics for PСP has been developed, which allows to reduce the further development of complications. The analysis of the results of the study and comparative results of different treatment methods allowed to identify groups of patients for traditional treatment in clinical practice - "open" surgery and minimally invasive technologies using the method of laser vaporization. In the dissertation work it is noted that the high efficiency of the developed method of minimally invasive surgical treatment with LV in combination with drug therapy (antibacterial and antispasmodic therapy, detoxification and vitamin therapy), safety of application, possibility of safe performance and availability of the specified means are justified by on the PСP and allow them to be recommended for widespread implementation in health care practice.