Kovalska I. Treatment of acute pancreatitis with priority of preservation exocrine and endocrine functions of pancreas

Dissertation dedicated to the questions of diagnosis, differential diagnosis and optimal treatment choice in patients with acute necrotic pancreatitis (ANP) with the priority of preservation of exocrine and endocrine functions of pancreas There were created: new clinico-morphologic classification of ANP; diagnostic algorithm with use of marcers of severity of ANP and development of pancreatic infection; treatment program with use of low-molecular weight heparin, selective paravertebral chemical denervation, extracorporeal detoxification, early small-invasive operations for biliary ANP, minimally traumatic operative techniques (sequesterectomy), closed draining with prolonged lavage. Use of developed diagnosis and treatment program lead to decrease of patients with exocrine (from 66,7% to 53,6% for conservative treatment, from 79,4% to 47,1% for surgical treatment) and endocrine insufficiency (from 20,0% to 17,9% for conservative and from 64,7% to 29,9% for surgical treatment), and also patients with chronic post-necrotic pancreatitis. Mortality in patients with ANP decreased from 9,4% to 8,4%, and postoperative mortality from 22,1% to 14,5%.