EARLY RHEOLOGICAL DRUG THERAPY AND STIMULATION OF DELIMITING PROCESSES IN PATIENTS SUFFERING FROM ACUTE PANCREATITIS
Rubrics: INTERNAL DISEASES
Authors:
1.
Altai State Medical University
(Department of Advanced Level Surgery, Head)
Barnaul, Barkaul, Russian Federation
Barnaul, Barkaul, Russian Federation
2.
Altai State Medical University
(Department of Intermediate Level Surgery named after I.I. Neymark and Advanced Level Surgery with the course of Continuing Professional Education, Professor)
employee from 01.01.1920 until now
Barnaul, Barkaul, Russian Federation
employee from 01.01.1920 until now
Barnaul, Barkaul, Russian Federation
Type:
Article
Pages:
from 9
to 16
Status:
Published
Received:
14.11.2017
Accepted:
30.11.2017
Published:
30.11.2017
Subject area:
UDK 61 Медицина. Охрана здоровья
Language:
Russian
Keywords:
ostryy pankreatit, pankreonekroz, zabryushinnaya kletchatka, otgranichitel'nyy tkanevoy bar'er, maloinvazivnye tehnologii, lokal'naya reologicheskaya terapiya
Abstract (English):
Proveden analiz hirurgicheskogo lecheniya 470 bol'nyh s ostrym pankreatitom, oslozhnennym pankreonekrozom, kotorye v zavisimosti ot taktiki lecheniya byli razdeleny na dve gruppy. V pervuyu gruppu voshli 314 pacientov s inficirovannym pankreonekrozom (224 – zabryushinnye flegmony i 90 – abscessy), v lechenii kotoryh primenyalis' rannie otkrytye nekrektomii v processe provedeniya laparotomii v pervye 3–5 sutok. Vtoruyu gruppu sostavili 156 bol'nyh s ispol'zovaniem sberegatel'noy taktiki v techenie 4–8 nedel', vo vremya kotoroy primenyalis' tehnologii otgranicheniya gnoyno-nekroticheskogo processa (98 – lokal'naya vnutriarterial'naya reologicheskaya terapiya, 46 – videolaparoskopicheskoe drenirovanie, 12 – dekompressionnyy retroperitoneal'nyy drenazh) s posleduyuschim maloinvazivnym drenirovaniem (transabdominal'noe, transgastral'noe). Otkrytye operacii v etoy gruppe vypolnyalis' «po trebovaniyu», v osnovnom pri progressirovanii gnoyno-nekroticheskogo processa. Blizhayshie rezul'taty lecheniya pokazali, chto rannie rasshirennye operacii po povodu inficirovannogo retroperitoneonekroza soprovozhdayutsya znachitel'noy letal'nost'yu, kotoraya pri zabryushinnyh flegmonah dostigala 55,4 %. Naprotiv, sberegatel'naya taktika, napravlennaya na otgranichenie processa v zabryushinnoy kletchatke i ego posleduyuschee maloinvazivnoe drenirovanie, harakterizovalas' bolee nizkimi letal'nymi sluchayami – 31 (19,9 %) bol'noy. Sredi naibolee effektivnyh tehnologiy hirurgicheskogo lecheniya pankreonekroza, sposobstvuyuschih uskorennomu formirovaniyu otgranicheniya v podzheludochnoy zheleze i zabryushinnoy kletchatke, sleduet otmetit' provedenie rannego videolaparoskopicheskogo drenirovaniya (letal'nost' – 10,9 %) i lokal'noy reologicheskoy lekarstvennoy terapii (letal'nost' – 21,4 %).
Proveden analiz hirurgicheskogo lecheniya 470 bol'nyh s ostrym pankreatitom, oslozhnennym pankreonekrozom, kotorye v zavisimosti ot taktiki lecheniya byli razdeleny na dve gruppy. V pervuyu gruppu voshli 314 pacientov s inficirovannym pankreonekrozom (224 – zabryushinnye flegmony i 90 – abscessy), v lechenii kotoryh primenyalis' rannie otkrytye nekrektomii v processe provedeniya laparotomii v pervye 3–5 sutok. Vtoruyu gruppu sostavili 156 bol'nyh s ispol'zovaniem sberegatel'noy taktiki v techenie 4–8 nedel', vo vremya kotoroy primenyalis' tehnologii otgranicheniya gnoyno-nekroticheskogo processa (98 – lokal'naya vnutriarterial'naya reologicheskaya terapiya, 46 – videolaparoskopicheskoe drenirovanie, 12 – dekompressionnyy retroperitoneal'nyy drenazh) s posleduyuschim maloinvazivnym drenirovaniem (transabdominal'noe, transgastral'noe). Otkrytye operacii v etoy gruppe vypolnyalis' «po trebovaniyu», v osnovnom pri progressirovanii gnoyno-nekroticheskogo processa. Blizhayshie rezul'taty lecheniya pokazali, chto rannie rasshirennye operacii po povodu inficirovannogo retroperitoneonekroza soprovozhdayutsya znachitel'noy letal'nost'yu, kotoraya pri zabryushinnyh flegmonah dostigala 55,4 %. Naprotiv, sberegatel'naya taktika, napravlennaya na otgranichenie processa v zabryushinnoy kletchatke i ego posleduyuschee maloinvazivnoe drenirovanie, harakterizovalas' bolee nizkimi letal'nymi sluchayami – 31 (19,9 %) bol'noy. Sredi naibolee effektivnyh tehnologiy hirurgicheskogo lecheniya pankreonekroza, sposobstvuyuschih uskorennomu formirovaniyu otgranicheniya v podzheludochnoy zheleze i zabryushinnoy kletchatke, sleduet otmetit' provedenie rannego videolaparoskopicheskogo drenirovaniya (letal'nost' – 10,9 %) i lokal'noy reologicheskoy lekarstvennoy terapii (letal'nost' – 21,4 %).
Keywords:
ostryy pankreatit, pankreonekroz, zabryushinnaya kletchatka, otgranichitel'nyy tkanevoy bar'er, maloinvazivnye tehnologii, lokal'naya reologicheskaya terapiya
ostryy pankreatit, pankreonekroz, zabryushinnaya kletchatka, otgranichitel'nyy tkanevoy bar'er, maloinvazivnye tehnologii, lokal'naya reologicheskaya terapiya
1. Rannyaya reologicheskaya lekarstvennaya terapiya
