[Overview of international recommendations on approaches a view of a physician and surgeon].

In different countries a set of recommendations for the diagnostics and treatment of chronic pancreatitis (CP) have been published, but to date a unified systematic management has not been developed yet. Because CP is within the interests of physicians of various specialties: surgeons, gastroenterologists, endoscopists and others, approaches to the most effective treatment--conservative therapy, endoscopic or surgical treatment--should be determined on an equal footing on the basis of well-known and well-conducted trials at the minimization of possible interpretations of the terms and tactics. In most cases there is a need for a comprehensive approach, which allows to achieve the main tasks: to cut pain short, maintain the function of the gland and/or compensate for pancreatic insufficiency, eliminate or prevent the development of complications, using a combination of the most effective methods of treatment. The opinion of all involved in the fate of particular patient specialists in the absence of common international standards, must be based on the results of the research evidence. The purpose of this review is to analyze the scientific studies in this field with a focus on existing practical guide of pancreatilogical associations of different countries of the world. Formulated during the analysis, the conclusions and provisions on the basis of strict methodological approach can be useful for Russian gastroenterologists, surgeons and general practitioners.

[Diagnosis and treatment of cystic forms of duodenal dystrophia].

Cystic dystrophy of duodenal wall and duodenal dystrophy (DD)--is a rare disease which is based on chronic inflammation of the pancreas tissue (PT), malrelated in the wall of the duodenum (DU). The principal method of surgical treatment of this disease is Pancreaticoduodenectomy (PRD), although it was presented several reports of successful use sandostatin or endoscopic treatment in some patients. Analysis of demographic, clinical and instrumental data, methods of surgical treatment of DD showed that all patients with persistent or recurrent abdominal pain was noted in all patients, weight loss--51%, vomiting--at 26%, jaundice--in 20% of patients. The most accurate diagnostic methods were CT, endo-ultrasound and MRI. The diagnosis of duodenal dystrophy installed in 35 patients. Operations were performed on 22 patients: Implemented PRD (10), removal of pancreatic head resection with a vertical branch of the PT and duodenoduodenoanastomosis (2), pancreatic head resection with excision of the cyst wall of the first portion of duodenum (2), gastric resection (1), resection of the vertical branch of the duodenum with duodenoduodenoanastomosus (2), duodenectomia (1) and resection of the vertical branch of the duodenum with reconstruction of the intestinal insert (2). Four patients fulfilled draining intervention on pancreatic ductal system--pankreatico and cystoenteroanastomoses. Postoperative and late mortality--0.77% of patients the disappearance of pain and 23%--a decrease in its intensity. In two cases, after the PRD against the background of pronounced chronic pancreatitis observed impaired glucose tolerance. Cystic dystrophy of duodenal wall without the expressed "orthotopic" pancreatitis clearly shows pathogenetic, clinical, diagnostic and therapeutic aspects of this disease, causing the possibility of an effective surgical treatment, only limited intervention by the KDP, without resection of the pancreas.