[Treatment strategy for complicated pancreatic pseudocysts]. / Vybor taktiki lecheniya oslozhnennykh psevdokist podzheludochnoi zhelezy.

OBJECTIVE: To analyze an effectiveness of various surgical approaches for complicated pancreatic pseudocysts. MATERIAL AND METHODS: The results of surgical treatment were analyzed in 188 patients with complicated pancreatic pseudocysts. The study included patients with one of complications of pseudocyst (infection, bleeding, compression of adjacent organs, perforation). Depending on surgical treatment, patients were divided into 2 groups: the 1st group (76 patients) - laparotomy followed by certain open surgery, the 2nd group (112 patients) - various minimally invasive treatments without further open operations. RESULTS: Effectiveness of surgical treatment was analyzed considering incidence of complications (postoperative wound suppuration, pneumonia, sepsis, multiple organ failure) and mortality. In the 1st group, postoperative wound suppuration - 22 (29%) patients, pneumonia - 17 (22.4%), sepsis - 14 (18.4%) patients, multiple organ failure - 14 (18.4%), 15 (19.8%) patients died. In the 2nd group, these values significantly differed: postoperative wound suppuration - 9 (8%), pneumonia - 5 (4.3%), sepsis - 1 (0.9%), multiple organ failure - 4 (3.5%), 1 (0.9%) patient died. CONCLUSION: Minimally invasive measures are the most optimal for any complication of pancreatic pseudocyst. Laparotomy is indicated if minimally invasive intervention is impossible for certain reason. It is advisable to concentrate these patients in specialized centers.

[Indicators of the quality of life of patients with chronic biliary pancreatitis after various options for surgical treatment].

life indicators of patients (n=365) with chronic biliary pancreatitis before the operation, 6 months and up to 10 years after surgical intervention were studied. It was found that the decrease in the quality of life of patients before surgey is mainly due to pain syndrome. After 6 months after the operation, the work capacity and physica activity are gradually restored against the background of a reduction in the pain syndrome. In the late period, the greatest importance is acquired dyspeptic disorders and reduced physical performance. The use of minimally invasive technologies lea to a faster recovery of the quality of ljfe indicators of patients in the postoperative and remote periods, the use of minimally invasive techniques and the dissociation of the common biliary and pancreatic ducts do not have signficant dgeferences and are close to the norm. The worst quality of ljfe was observed in patients who underwent the imposition of choledochusduodenoanastomosis. Qualiy of.

[Minimally invasive technologies in the treatment of severe forms of acute pancreatitis at various periods of the disease]. / Maloinvazivnye tekhnologii v lechenii tiazhelykh form ostrogo pankreatita v razlichnye periody zabolevaniia.

The choice of the optimum technique of the sanitation procedure in treatment of acute necrotizing pancreatitis (ANP) is now one of the most disputable problems. Clinical estimation of the efficiency of various operative techniques of treatment of ANP at various stages of disease has been made. In the aseptic phase laparoscopic decompression of the pancreas is indicated when the patient has evident hemorrhagic parapancreatitis. In the phase of septic sequestration of ANP the optimum method of minimally invasive surgical intervention is considered to be minilaparotomy which is expedient for abscesses of small volume, lipid abscesses of any volume with the minimal content of necrotizing tissues as the first step of sanitation in critical patient. High quantity of the necrotizing tissues in the zone of the destructive focus requires traditional laparotomy of the abscess under conditions of preventive maintenance of the endotoxic shock.