Honcharova N. Diagnosis and surgical treatment of complicated pancreatic pseudocyst.

In the work based on the analysis of the results of the examination and surgical interventions, 505 patients with complicated pancreatic pseudocysts were given data on the basis of which the scientific and theoretical positions on the formation of a new direction in the diagnosis, pathogenesis, prognosis, prevention and complex treatment of patients with different types of pseudocyst . The scientific hypothesis that under the conditions of hypoxia and ischemia of the pancreas due to its damage, under the influence of angiogenic factors, there is activation and proliferation of endotheliocytes, which concludes with neovascularization, and insufficient degradation of the extracellular matrix and its accumulation are the main cause of progression of pancreatic fibrosis and remodeling with development complications of the disease. The indices of the liver and splanchnic blood flow status were determined; the main morphofunctional changes in the walls of different types of pseudocysts were studied. In the work, studies on the expediency of using different methods of minimally invasive surgical interventions have been supplemented, their comparative analysis has been carried out, and based on the data obtained, methods for treating patients with complicated pseudocysts of the pancreas have been optimized by individualizing surgical tactics. Advanced surgical techniques have been developed: a method for the formation of pancreatoenteroanastomosis, a method for the formation of pancreatogastroanastomosis, a method for the surgical treatment of pancreatic pseudocysts complicated by suppuration; a method of surgical treatment of pseudocysts of the pancreas, complicated by bleeding into the pseudocyst cavity; a method of treatment of infected pseudocysts of the pancreas with retroperitoneal location on the background of chronic pancreatitis; a method for the formation of pancreatogastroanastomosis, a method for treating chronic pancreatitis complicated by the obstruction of the terminal part of the choledochus; a method for predicting the complicated course of postoperative pancreatitis; confirmed their effectiveness. The obtained development data allowed reducing the number of postoperative complications and lethality. The forecasting of complications in the early postoperative period was carried out and the quality of life of patients was determined, and the essential advantages of minimally invasive methods of treatment over laparotomic were demonstrated.