[Early diagnosis and surgical tactics at acute destructive pancreatitis].

Based on retrospective analysis of 292 case histories of patients with acute pancreatitis the computed model permitted to differentiate destructive and hydropic pancreatitis and to predict clinical course of pancreonecrosis has been constructed. Algorithm of treatment tactics depending on this analysis has been developed. Use of laparoscopy in early period with results of computed prognosis permitted to decrease the rate of diagnostic mistakes at pancreonecrosis from 59.2 to 39.5%. Algorithm of surgical tactics permitted to reduce lethality at small- and medium-focal pancreonecrosis from 51.7 to 5.1%, and the rate of purulent complication--from 23.8 to 2.5%.

[Diagnosis and surgical strategy for acute pancreatitis]. / Diagnostika i khirurgicheskaia taktika pri ostrom pankreatite.

Problems with early diagnosis and assessment of the severity of acute pancreatitis (AP) are discussed on the basis of great clinical material (1340 patients). A test of the autoantibody formation was used in the examination of 83 patients with AP and 26 healthy donors as a diagnostic and prognostic criterion of AP. It was shown that the test for the formation of autoantibodies in patients with AP had a direct correlation with other markers of endogenous intoxication, and can be taken as an additional objective criterion for the assessment of the severity of the disease and effectiveness of the treatment used, and allows to make a prognosis of the outcome. In addition, a comparative analysis was made of two periods of work of the stuff of the surgical department: 1--the active surgical strategy during the acute phase of acute destructive pancreatitis (ADP); 2--intensive conservative therapy with using less invasive interventions. The change of the medical strategy allowed to get a reliable reduction of general mortality from ADP from 46.6 to 27.6% and to decrease the number of purulent complications to 27%.