OPTIMIZATION OF MINIMALLY INVASIVE TREATMENT OF PATIENTS WITH EXTENSIVE PANCREATOGENIC NECROSES

Aim. To assess the efficiency of staged and simultaneous drainage of wide-spread pancreatogenic phlegmons.

Material and Methods. The results of treatment 146 patients with wide-spread phlegmons were studied (2—4 quadrants). All patients were operated via small access. The first group included 46 patients in whom affected departments of retroperitoneal space were operated and drained during primary surgery. The second group consisted of 100 patients after staged treatment. Herewith the most affected quadrant was drained, other suppurative areas were operated in 1—2 days after stabilization of patient and septic shock elimination. Diagnostics included clinical laboratory tests and instrumental methods (USR, CT, PGDS) for all categories of patients. SOFA scale was used for integral assessment of condition severity and sepsis-associated organ failure. The amount of drainage was determined in accordance with intended extent of retroperitoneal lesion.

Results. Average SOFA score was 8.8 ± 0.152. In most patients of the first group negative dynamics of condition with SOFA scores up to 9.2 ± 0.139 was noted for the first days after surgery. In the second group this indicator was unchanged (8.4 ± 0.114). During following days condition severity was 8.8 ± 0.142 in the first group and 3.2 ± 0.069 in the second group with the same duration of treatment. Organ failure was eliminated on the 9^th day in the first group and on the 7^th day in the second group. Mortality rate was higher in the first group (26.1%) compared with the second group (21.0%). The causes of death were infectious-toxic shock and irreversible pathological condition in both groups respectively. The average duration of treatment was 29.3 days in both groups.

Conclusion. Surgical treatment of patients with pancreatogenic phlegmons includes common space formation, external drainage through the incisions, programmed sanations. Mini-invasive accesses should be preferred. Staged surgical treatment for wide-spread retroperitoneal pancreatogenic phlegmons provides adequate drainage with less risk of infectious-toxic shock development and better results.

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