Purulent-Necrotic Parapancreatitis: the Evolution of Views on Treatment

V. R. Goltsov; V. E. Savello; A. M. Bakunov; D. A. Dymnikov; D. M. Kurochkin; E. V. Batig

doi:10.16931/1995-5464.2015375-83

Purulent-Necrotic Parapancreatitis: the Evolution of Views on Treatment

V. R. Goltsov, V. E. Savello, A. M. Bakunov, D. A. Dymnikov, D. M. Kurochkin, E. V. Batig

https://doi.org/10.16931/1995-5464.2015375-83

Bagnenko S.F., Kurygin A.A., Sinenchenko G.I. Khirurgicheskaja pankreatologija [Surgical pancreatology]. S.-Peterburg: Speech, 2009. 608 p. (In Russian) Prudkov M.I. Klinicheskie rekomendacii po okazaniju medicinskoj pomoshhi naseleniju Ural'skogo federal'nogo okruga [Clinical guidelines for health care to the population of the Ural Federal District]. Ekaterinburg, 2013. p. 23–29. (In Russian) Savelyev V.S., Filimonov M.I., Burnevich S.Z. Pankreonekrozy [Pancreatic necrosis]. Moscow: MIA, 2008. 264 p. (In Russian) Tolstoy A.D., Sopiya R.A., Krasnorogov V.B., Vashetko R.V., Goltsov V.R., Andreev M.I. Destruktivnyj pankreatit i parapankreatit [Destructive pancreatitis and parapancreatitis]. Saint-Petersburg: Hippocrates, 1999. 128 p. (In Russian) Banks P.A., Freeman M.L. Practice Guidelines in Acute Pancreatitis. Am. J. Gastroenterol. 2006; 101: 2379–2400. Beger H.G., Matsuno S., Cameron J.L. Diseases of the pancreas. Current surgical therapy. Springer – Berlin, Heidelberg, New York. 2008. 950 p. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Working Group IAP/APA (International Association of Pancreatology /American Pancreatic Association) Acute Pancreatitis Guidelines. Pancreatology. 2013; 13: 1–15. Uhl W., Warshaw A., Imrie C., Bassi C., McKay C., Lankisch P., Carter R., Di Magno E., Banks P., Whitcomb D., Dervenis C., Ulrich C., Satake K., Ghaneh P., Hartwig W., Werner J., McEntee G., Neoptolemos J., Buchler M. IAP Guidelines for the Surgical Management of Acute Pancreatitis. Pancreatology. 2002; 2: 565–573. Tolstoy A.D., Panov V.P., Krasnorogov V.B., Vashetko R.V., Skoro dumov A.V. Parapankreatit (jetiologija, patogenez, diagnostika, lechenie) [Parapancreatitis (etiology, patho genesis, diagnosis, treatment)]. Saint-Petersburg, 2003. 256 p. (In Russian) Bradley E.L. 3rd. A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis, Atlanta, 1992. Arch. Surg. 1993; 128: 586–590. Tolstoy A.D., Bagnenko S.F., Krasnorogov V.B., Kurygin A.A., Grinev M.V., Lapshin V.N., Goltsov V.R. Acute pancreatitis (diagnostic and treatment protocols). Khirurgiia. Zhurnal imeni N.I. Pirogova 2005; 7: 19–23. (In Russian) Ivshin V.G., Ivshin M.V. Chreskozhnoe lechenie bol'nyh s pankreonekrozom i rasprostranjonnym parapankreatitom [Percutaneous treatment of patients with pancreatic necrosis and extended parapancreatitis]. Tula: Grif and K, 2013. 128 p. (In Russian) Dyuzheva T.G., Dzhus E.V., Shaefer A.V., Akhaladze G.G., Chevokin A.Yu., Kotovskiy A.E., Platonova L.V., Galperin E.I. Configuration of pancreatic necrosis and differentiated treatment of acute pancreatitis. Annaly khirurgicheskoy gepatologii. 2013; 18 (1): 92–102. (In Russian) Bagnenko S.F., Savello V.E., Goltsov V.R. Luchevaja diagnostika zabolevanij podzheludochnoj zhelezy: pankreatit ostryj / Luchevaja diagnostika i terapija v gastrojenterologii: nacional'noe rukovodstvo (gl. red. toma G.G. Karmazanovskij) [Radiological diagnosis of pancreatic diseases: acute pancreatitis / Radiological diagnosis and therapy in gastroenterology: national leadership (chief editor of the volume Karmazanovsky G.G.)]. Moscow: GEOTAR Media, 2014. p. 349–365. (In Russian) Seldinger S.I. Catheter replacement of the needle in percutaneous arteriography; a new technique. Acta Radiologica. 1953; 39 (5): 368–376.

Full Text:

PDF (Rus)

Generate QR code

Abstract

Aim. To develop more effective methods of surgical treatment of patients with purulent-necrotic parapancreatitis.
Material and Methods. Treatment of 819 patients with purulentnecrotic parapancreatitis was analyzed. The volume of
pancreatic necrosis and extent of purulent-necrotic parapancreatitis were determined according to multispiral computed tomographic angiography or magnetic resonance imaging, as well as during surgery or autopsy. Different surgical methods were compared depending on time and type of surgery. Effectiveness was estimated according to incidence of complications, severe sepsis and mortality rate.
Conclusion. Minimally invasive drainage under x-ray guidance with step-by-step replacement of drains to larger diameter followed by aspiration and/or instrumental necrosectomy is preferable in treatment of purulent-necrotic parapancreatitis. Laparotomy with necrosectomy are ad-visable if minimally invasive procedures are ineffective.