The dissertation is devoted to the current problems in surgery, improving the
results of acute pancreatitis (AP) treatment in pregnant women through early
diagnosis and treatment approaches.
This research included 123 pregnant women who were treated for AP in the
clinic of the Department of Surgery and Proctology of the Shupyk National
Healthcare University of Ukraine and Kyiv Regional Center for Maternal and Child
Healthcare and Department of Obstetrics and Gynecology No.1. To solve the
research tasks, patients were divided into two groups depending on the diagnostic
and treatment approaches used. The main group included 61 pregnant women with
an average age of 28.41±7.28 years, who were examined and treated according to
the developed diagnostic and treatment algorithm, which included, in addition to
general clinical, laboratory and biochemical, instrumental methods of examination
and research of pancreatic elastase in blood serum, as well as the use of modern
minimally invasive techniques, such as endoscopic papillotomy, puncture,
ultrasound-guided aspiration and drainage of fluid, laparoscopic cholecystectomy
with drainage of the common bile duct. The control group included 62 pregnant
women with an average age of 27.76±6.53, who were diagnosed and treated
traditionally. Examination of the pregnant women in the control group included
studying complaints and medical history and performing traditional laboratory and
instrumental research methods. The pancreatic elastase in blood serum was not
measured in this group. The results of laboratory diagnostics and ultrasound were
compared, and treatment included conservative therapy and open surgical
interventions with primary cesarean section, hysterectomy, and necrosequestrectomy. The selected groups of pregnant women were comparable in terms
of basic clinical and demographic characteristics: age, body weight, place of
residence, gestational age, time from the onset of the disease to hospitalization, and
frequency of concomitant somatic pathology.
The research methodology involved assessing complaints, anamnesis, the
patient's general somatic condition, laboratory assessment, and sonographic
indicators.
The criteria for evaluating the effectiveness of treatment were: the success rate
of early diagnosis of AP, the frequency of minimally invasive surgical techniques,
the frequency of open surgical interventions, the frequency of complications, and
mortality.
The obtained results of the study allow us to state that traditional diagnostic
methods, which include clinical signs, determination of serum amylase and lipase,
and ultrasound, allow diagnosing AP in pregnant women in the early stages in
48.4% of cases. The reasons for the late disease diagnosis are: delayed seeking of
medical care (≥48 hours) in 27.4% of cases, non-profile emergency hospitalization
after the onset of the first symptoms of acute pancreatitis in 80.6% of cases, the
variability of clinical symptoms of AP in pregnant women, in particular, the absence
of pain syndrome in 30.6%, deelayed ultrasound examination with the absence of
typical sonographic changes of pancreatitis in 51.6% of pregnant women, the
insufficient sensitivity and specificity of amylasemia (sensitivity 74.2%, 68.7%) and
lipasemia (sensitivity 77.4%, specificity 90.3%) for diagnosing the disease.
The scientific novelty lies in the expansion of scientific data on the features of
the clinical course of AP in pregnant women, taking into account the timing and
profile of hospitalization, the variability of clinical, laboratory, and sonographic
changes, and their significance for early diagnosis of the disease.
It was found that the late AP diagnosis in pregnant women is the reason for
the absence of effect from conservative therapy in 66.1% of cases, the progression
of a severe course of AP (pancreatic necrosis – 32.3% of cases, inflammatory
changes in the retroperitoneal fat tissue – 12.9%, formed necrotic pancreatic and
peripancreatic fluid accumulations – 12 (19.4%)), which determined the need for
open surgical interventions in 38.7% of patients, as well as the presence of 3.2% of
fatal cases.
Scientific data on the diagnostic value of the pancreatic elastase in blood
serum for the verification of early stages of AP in pregnant women have been
supplemented.
For the first time, it was established that the improved complex diagnostic
algorithm, which is based on the determination of the concentration of pancreatic
elastase in the blood serum, contributes to the increase in the frequency of diagnosed
cases of AP in the early stages from 48.4% to 100%, and the reduction of the
average verification time of the disease by 2.7 days from the onset of its first
symptoms, compared to the group of patients without elastase determination in
blood serum.
