91246 (Діагностика і операційна тактика при постнекротичних ускладненнях гострого панкреатиту), страница 5

Предложенная комплексная лечебно-диагностическая программа у больных с постнекротическими осложнениями острого панкреатита позволила снизить послеоперационную летальность на 5,9%.

Ключевые слова: острый панкреатит, гнойные осложнения, постнекротическая киста поджелудочной железы, диагностика, лечебная программа.

THE ANNOTATION

Croyzik K.L. Diagnostics and operative tactics at the post necrotic complications of the acute pancreatitis. - The Typescript.

The dissertation on competition of the scientific degree of the candidate of medical sciences on a speciality 14.01.03 - surgery. The Crimean state medical university of S.I.Georgievsky MPH of Ukraine, Simferopol, 2008.

The method of program calculation of the volume involved into the inflammatory-necrotic process of fabrics is offered. In interrelation with the offered monitoring of the infection degree of fabrics it has allowed to establish the dependence of transition the aseptic inflammations to the purulent stage. The threshold size of the volume necrotic structures the excess of which inevitably leads to the abscess formation is established. For the first time at patients with the post necrotic complications of the acute pancreatitis the interrelation of distribution necrotic fabrics with the degree of infection is studied. The criterion of calculation of the liquid-infiltrative volume formations in the estimation of the severity level of the patients` condition is offered. It is proved, that possibilities of the directed antibacterial preventive maintenance for the prevention of the abscess formations are limited by the scale necrotic centre. According to the received data, the volume excess of the inflammatory-necrotic centre more than 200 sm³ in 91,7 % of cases lead to the abscess formation. It serves as the indication for the timely operative treatment.

In operative treatment the method of the programmed aspirating and minimally invasive interventions with the step-wise transition to the expanded access on stabilization of the patient’s condition is offered. The same algorithm is applied to the treatment of the post necrotic cysts of the pancreas. The staging approach in the surgical tactics allows to stabilize the condition of patients, to prevent transition of the system inflammatory reaction into the septic process. The success of the minimally invasive tactics is caused by the timely adequate the zones drainage of the purulent inflammation. It conducts to the improvement of a condition of patients and the performance possibility in the subsequent programmed operative interventions of more extensive character.

The offered complex medical-diagnostic program at patients with the post necrotic complications of a acute pancreatitis has allowed to lower the postoperative lethality on 5,9%.

Key words: acute pancreatitis, purulent complications, post necrotic cyst of the pancreas, diagnostics, the medical program.

ПЕРЕЛІК УМОВНИХ ПОЗНАЧЕНЬ І СКОРОЧЕНЬ

АЛТ - аланіновая трансаміназа

АСТ - аспарагіновая трансаміназа

КТ - комп'ютерна томографія

ЛДГ - лактатдегідрогеназа загальна

ЛІІ - лейкоцитарний індекс інтоксикації

МСМ - молекули середньої маси

МРТ - магніто-резонансна томографія

ЗАК - загальний аналіз крові

ЗАС - загальний аналіз сечі

ГП - гострий панкреатит

ПЗ - підшлункова залоза

ПКТ - прокальцітонин

ЛФ - лужна фосфатаза

ПОН - поліоргана недостатність

СДГ - сукцінатдегідрогеназа

СКТ - спіральна комп'ютерна томографія

СОЕ - швидкість осідання еритроцитів

УЗД - ультразвукове дослідження

ЕФГДС - єзофагогастродуоденоскопія

3D - (Daily, Digital, Digest), тривимірна графіка, тобто описувана трьома координатами по Х,Y і Z

SIRS - systemic inflammatory response syndrome (синдром системний запальної відповіді)