Percutaneous Interventions with Necrotic Suppurative Complications of Pancreatonecrosis

Purpose. Determination of criterions of efficiency, duration and expediency for only minimally invasive techniques treatment of purulent necrotic complications of acute severe pancreatitis. Material and methods. The research is based on results of 115 treatment cases of purulent necrotic complications of acute severe pancreatitis. Patients were divided into 2 groups: first - 33 (28,7%) patients which had received traditional operation; second - 82 (71,3%) patients received surgical treatment started with minimally invasive interventions. The Mumbai 2008 classification based on imaging diagnostics was used for comparative evaluation. Each group was divided into subgroups depending on severity of the disease. The classification of Filin-Tolstoy was used for the sub-division. Results. 6 (18%) patients from the first group had the following postsurgical complications: arrosive hemorrhage (5 cases), colic fistula (1 case). The hospital stay duration averages: 30,2±5,4 days for the mild cases group, 51,1 ± 9,2 for the severe cases group. Lethality averages 39,3% (13 cases). There was 1 lethal case in mild cases group as result of postsurgical arrosive hemorrhage. The lethality in severe disease group averages 36,3% (12 cases): as result of postsurgical arrosive hemorrhage (2 cases) and as result of developing multi-system organ failure (10 cases). There were 19 (23%) complications in second group: arrosive hemorrhage (5 cases), colic fistula (11 cases), pancreas fistula (14 cases). The hospital stay duration averages: 55,3±4,2 days for the mild severity group, 70,9±6,7 for severe disease group. It was discovered that lethality for second group were 2 times less and hospital stay duration were 1,5 times longer than for the first group. Conclusion. It is always possible to start with minimally invasive techniques under control of ultrasonic and X-ray imaging in cases of purulent necrotic complications of acute severe pancreatitis. However in case of intoxication syndrome retention it is necessary to take decision on corresponding necrosequestrectomy by means of laparothomy or imaging endosurgery.

панкреонекроз, гнойно-некротические осложнения, деструктивный панкреатит, миниинвазивные вмешательства, percutaneous interventions, acute severe pancreatitis, necrotic complications

1. Савельев B.C., Филимонов М.И., Бурневич С.З. Панкреонекрозы. М.: Медицинское информационное агентство, 2008. 264 с.

2. Багненко С.Ф., Курыгин А.А., Синенченко Г.И. Хирургическая панкреатология. СПб.: Речь, 2009. 608 с.

3. Beger H.G., Rau В., Mayer J., Isenman R. Surgical treatment of acute pancreatitis. Pancreatic disease state of the art and future aspects of research. 1998: 78-93.

4. Buchler M.W., Gloor B., Miiller C.A. et al. Acute necrotizing pancreatitis: Treatment strategy according to the status of infection. Ann. Surg. 2000; 232: 619-626.

5. Данилов М.В., Федоров В.Д. Повторные и реконструктивные операции при заболеваниях поджелудочной железы: Руководство для врачей. М.: Медицина, 2003. 424 с.

6. Нестеренко Ю.А., Шаповальянц С.Г., Лаптев В.В., Михайлусов С.В. Комплексное лечение деструктивного панкреатита в зависимости от фазы заболевания: Материалы Первого Московского международного конгресса хирургов. 1995: 158-160.

7. Beger H.G., Rau B.M. Severe acute pancreatitis: Clinical course and management. Wld J. Gastroenterol. 2007; 13 (38): 5043-5051.

8. Багненко С.Ф., Гольцов В.Р Острый панкреатит - современное состояние проблемы и нерешенные вопросы. Альманах Института хирургии им. А.В. Вишневского. 2008: 3 (3): 104-112.

9. Bradley E.L.III. A clinically based classification system for acute pancreatis. Summary of the international symposium on acute pancretitis. Atlanta, Ga, September 11-13, 1992: 586-590.

10. Савельев B.C., Филимонов М.И., Гельфанд Б.Р., Бурневич С.З. Деструктивный панкреатит. Стандарты диагностики и лечения. Анналы хирургической гепатологии. 2001; 6 (2): 115-122.

11. Besselink M., de Bruijn M.T., Rutten J.P. et al. Surgical intervention in patients with necrotizing pancreatitis. Br. J. Surg. 2006; 93 (5): 593-599.

12. Beger H.G., Matsuno S., Cameron J.L. Diseases of the Pancreas. Heidelberg: Springer-Verlag, 2008. 949 p.

13. Acute Pancreatitis Classification Working Group. Revision of the Atlanta classification of acute pancreatitis, http://www.pancreasclub.com/resources/AtlantaClassifi cation.pdf (9-4-2008). [Accessed March 2010].

14. Толстой А.Д., Панов В.П., Краснорогов В.Б. и др. Парапанкреатит. Этиология, патогенез, диагностика, лечение. СПб.: Ясный Свет, 2003. 256 с.

15. Багненко С.Ф., Захарова Е.В., Рысс А.Ю., Лапицкий А.В. Эффективность энтеральной терапии и нутриционной поддержки больных с острым деструктивным панкреатитом. Вестн. интенс. тер. 2008; 1: 1-5.

16. Trikudanathan G., Navaneethan U., Vege S.S. Intraabdominal fungal infections complicating acute pancreatitis: a review. Am. J. Gastroenterol. 2011; 106 (7): 1188-1192.

17. Van Santvoort H.C., Bakker O.J., Bollen T.L. et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology. 2011; 141: 1254.

18. Van Brunschot S., Bakker O.J., Besselink M.G. et al. Treatment of necrotizing pancreatitis. Clin. Gastroenterol. Hepatol. 2012; 10 (11): 1190-1201.

19. Wu B.U., Banks P.A. Clinical management of patients with acute pancreatitis. Gastroenterology. 2013; 144 (6): 1272-1281.

20. Freeny P.C., Hauptmann E., Althaus S.J. et al. Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis. Techniqes and results. Am. J. Roentgenol. 1998; 170: 969-975.

21. Uhl W., Warshaw A. Imrie C. et al. IAP guidelines for the surgical management of acute pancreatitis. Pancreatology. 2002; 2: 565-573.

22. UK guidelines for the management of acute pancreatitis. UK Working Party on Acute Pancreatitis. Gut. 2005; 54 (suppl. 3): iii1-iii9.

23. Freeman M.L., Werner J., van Santvoort H.C. et al. International Multidisciplinary Panel of Speakers and Moderators. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas. 2012; 41 (8): 1176-1194.

24. Bakker O.J., van Santvoort H.C., van Brunschot S. et al. Dutch Pancreatitis Study Group. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. J.A.M.A. 2012; 307 (10): 1053-1061.