[BILIARY HYPERTENSION IN CHRONIC PANCREATITIS AND PECULIARITIES OF ITS DIAGNOSIS].

Possibilities of various diagnostic methods for biliary hypertension detection in chronic pancreatitis were analyzed. Biliary hypertension was revealed in 163 (31%) patients, suffering chronic pancreatitis. The laboratory investigations data, ultrasonographic investigation, computer tomography, endoscopic retrograde cholangiopancreatography, magnet-resonance cholangiopancreatography, intraoperative measurement of the biliary ducts width, intraoperative measurement of biliary pressure were applied for diagnosis. Endoscopic retrograde cholangiopancreatography, magnet-resonance cholangiopancreatography and intraoperative measurement of biliary pressure are considered the most sensitive methods for chronic pancreatitis diagnosis.

ROLE OF BIOLOGICAL MARKERS IN DIAGNOSIS OF PURULENT­SEPTIC COMPLICATIONS OF AN ACUTE NECROTIC PANCREATITIS.

Examination and treatment of 70 patients, suffering an acute necrotic pancreatitits, was conducted. Content of presepsin, procalcitonin, С­reactive protein and interleukin­6 (ІL­6) 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 ІL­6 and С­reactive protein is characteristic for the systemic inflammatory response syndrome (SIRS) of infective and noninfective origin.

[ANALYSIS OF COMPLICATIONS POSTOPERATIVE CAUSES AND MORTALITY AFTER RADICAL TREATMENT FOR TUMORS OF THE LEFT ANATOMICAL SEGMENT OF THE PANCREAS].

Radical surgery for tumors of the left anatomical and surgical segment of the pancreas proved for distal resection in various versions, central resection and enucleation of tumors. The causes of early postoperative complications and mortality in 129 patients aged from 14 to 81 years, operated on for neoplastic lesions of the left anatomical segment of the pancreas in the period from 2009 to 2014 were analysed. The influence of various factors of risk of complications and mortality were studied in particular, extended resection, for tumor invasion of adjacent organs, and adjacent vessels.

[CONSERVATIVE THERAPY IN THE COMPLEX TREATMENT OF ACUTE NECROTIZING PANCREATITIS].

Developed and implemented a phased differentiated treatment tactics in acute necrotizing pancreatitis, based on the theory of phase course of acute pancreatitis. Treatment started with conservative measures. Applications developed set of measures allowed us to achieve recovery of 39.53% patients without any instrumental interventions performans, including diapevtycal. Laparotomy reduced frequency performance of 57.14%--in the control group to 33.07%--in the main. Mortality in the main group was 6.72%; complication rate decreased 2.26 times; postoperative mortality was 9.83%.

[MINIINVASIVE SURGICAL INTERVENTIONS FOR AN ACUTE NECROTIC PANCREATITIS].

A differentiated staged surgical tactics for treatment of an acute necrotic pancreatitis, based on theory of an acute necrotic pancreatitis phased course, was elaborated and introduced. Sanation and drainage under ultrasonographic control have promoted the patients state stabilization with further stage of laparotomic intervention, in 26.87% of patients of the main group were a residual interventions performed, while in a control group--in 13.19%. Efficacy of a videocontrolled sanation and drainage of retroperitoneal space, using nephroscope, was proved. New methods of miniinvasive surgical treatment of pancreonecrosis, the septic-purulent complications prophylaxis were elaborated. The rate of laparotomy performance was reduced from 57.14%--in a control group down to 33.07%--in the main group. Lethality in the main group was 6.72%, postoperative lethality--9.83%, a morbidity rate in patients have reduced in 2.26 times.

[SURGICAL TREATMENT OF TUMORS OF THE LEFT PANCREATIC ANATOMICAL SEGMENT].

The results of treatment of 231 patients, suffering tumoral affection of pancreatic left anatomical segment in period of 2009-2013 yrs were analyzed. Individualized approach, using modern technologies, was applied. Radical operations were performed in 129 patients, ageing 14-81 yrs old, including pancreatic distal resections in various modifications, central resection and tumoral enucleation. Possibilities of the extended pancreatic resection performance were studied in conditions of tumoral invasion of adjacent organs, regional vessels, as well as impact of such interventions on postoperative complications and lethality rate. While performing pancreatic subtotal distal resection with simultant resection of affected main venous vessels and adjacent organs the operative intervention risk is enhanced, but possibilities of a radical operations performance in previously considered inoperable patients are expanding.

[IMPACT OF A HEIGHTENED INTRAABDOMINAL PRESSURE ON POLYORGAN INSUFFICIENCY OCCURRENCE IN AN ACUTE PANCREATITIS].

In experiment the impact of intraabdominal hypertension (IAH) on an acute pancreatitis (AP) course was studied up. The procedure of an acute experiment, using intraparenchymatose introduction of 40% solution of ethanol, was proposed. The isolated influence of IAH on target organs was investigated, as well as its impact on the simulated severe AP course. Morphological changes in pancreas, small intestine, kidneys, liver in an AP were studied up. While performing the investigation a negative impact of IAH in AP was noted, such as the polyorgan insufficiency occurence.

[PROGNOSTIC SIGNIFICANCE OF ELEMENTS OF THE MULTIORGAN INSUFFICIENCY SYNDROME AND ESTIMATION OF THE PATIENTS STATE SEVERITY IN ACCORDANCE TO INTEGRAL SCALES IN AN ACUTE NECROTIC PANCREATITIS].

There were examined 113 patients, in whom an acute necrotic pancreatitis was diagnosed. While admittance to hospital a constant organ insufficiency was revealed in 50 (44%), a transient one--in 63 (56%) patients. In total 31 (27.4%) patients died. Respiratory insufficiency have occurred in 67% patients, and almost with similar rate--cardio-vascular (in 59%), renal (in 56%) and enteral (in 54%), dominating in the lethality structure. The BISAP (Bedcide Index for Severity in Acute Pancreatitis) scales applied permit with high probability to prognosticate the organ insufficiency and lethality in patients, suffering an acute necrotic pancreatitis.