RESUMO
Combined method of laparoscopically and retroperitoneoscopically assisted necrsequestrectomy, consisting of staged application of miniinvasive methods with simultaneous laparoscopic and retroperitoneoscopic control of necrsequestrectomy, was elaborated with the objective to improve surgical treatment of an acute pancreatitits. The procedure has significant advantages over open operative intervention in purulent complications of necrotic purulent pancreatitis: reduction of the local and systemic operative treatment severity, minimization of microbial metabolites coming into the blood, total visual control of intervention, reduction of the vascular injuries risk, аdequate surgical sanation with saving of viable pancreatic parenchyma, absence of conditions for the purulent complications occurrence while the operative wound healing is going on, preservation of possibility for an adequate draining, using drains of a large diameter.
Assuntos
Laparoscopia/métodos , Pâncreas/cirurgia , Pancreatectomia/métodos , Pancreatite Necrosante Aguda/cirurgia , Espaço Retroperitoneal/cirurgia , Supuração/cirurgia , Idoso , Antibacterianos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Drenagem/instrumentação , Drenagem/métodos , Feminino , Humanos , Laparoscopia/instrumentação , Pâncreas/microbiologia , Pâncreas/patologia , Pancreatectomia/instrumentação , Pancreatite Necrosante Aguda/tratamento farmacológico , Pancreatite Necrosante Aguda/microbiologia , Pancreatite Necrosante Aguda/patologia , Espaço Retroperitoneal/microbiologia , Espaço Retroperitoneal/patologia , Supuração/tratamento farmacológico , Supuração/microbiologia , Supuração/patologia , Resultado do TratamentoRESUMO
Influence of therapeutic plasmapheresis on bowel barrier function and evacuation was investigated in 83 patients with severe acute necrotizing pancreatitis. Except standard therapy patient obtained therapeutic plasmapheresis using "Haemonetics" PCS 2 system. Complex treatment of patients with acute necrotizing pancreatitis and dynamic ileus using plasmapheresis increases contractive and propulsive function of stomach and duodenum and prolongs period of activity of these organs on 32%. Intestinal barrier function associates with restoration of bowel evacuation. Addition of plasmapheresis to standard therapy of necrotizing pancreatitis can be effective prevention of dynamic ileus.
Assuntos
Motilidade Gastrointestinal/fisiologia , Obstrução Intestinal/prevenção & controle , Intestinos/fisiopatologia , Pancreatite Necrosante Aguda/terapia , Plasmaferese/métodos , Estômago/fisiopatologia , Mucosa Gástrica/metabolismo , Humanos , Mucosa Intestinal/metabolismo , Obstrução Intestinal/sangue , Obstrução Intestinal/fisiopatologia , Pancreatite Necrosante Aguda/sangue , Pancreatite Necrosante Aguda/fisiopatologia , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
62 patients with acute pancreatitis (AP) were examined in order to determine hemocoagulation disorders. The obtained results showed that the patients developed the consumptive coagulopathy with high levels of D-dimer, activation and exhaustion of antithrombin III (AT III). The development of hemocoagulation disturbances in patients with severe AP was confirmed through decrease of activity of AT III up to 68% and high level of D-dimer>693 ng/ml.
