Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias da Vesícula Biliar/diagnóstico , Hemorragia/diagnóstico , Neoplasias Hepáticas/diagnóstico , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Colecistectomia , Colecistite/diagnóstico , Colecistite/patologia , Colecistite/cirurgia , Evolução Fatal , Feminino , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/patologia , Hemorragia/patologia , Histocitoquímica , Humanos , Fígado/patologia , Neoplasias Hepáticas/secundárioRESUMO
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
Examination and treatment of 70 patients, suffering an acute necrotic pancreatitits, was conducted. Content of presepsin, procalcitonin, Сreactive protein and interleukin6 (ÐL6) in the patients' blood plasma was determined, and bacteriological investiga' tions, contrastenhanced CT were conducted as well. Positive results of bacteriologi' cal investigations were noted in 43 patients. Level of presepsin and procalcitonin in patients, suffering purulentseptic complications, in 3 4 times exceeded such in a sterile pancreonecrosis. Presersin level,exceeding over 632 pg/ml, have permitted to confirm the presence of local and systemic infection with high specificity and sensitivi' ty, and this have exceeded diagnostic possibilities of the procalcitonin content determi' nation. High level of ÐL6 and Сreactive protein is characteristic for the systemic inflammatory response syndrome (SIRS) of infective and noninfective origin.
