IMPROVEMENT OF RESULTS OF TREATMENT OF ACUTE BILIARY PANCREATITIS

Aim. Improvement of the results of surgical treatment of acute biliary pancreatitis (BP), using combined miniinvasive technologies. Materials and methods. The work is based on an analysis of the results of diagnosis and treatment of 126 patients with acute BP. The age of the patients ranged from 21 to 82 years. 92 (73.0) women and 34 (27.0%) men participated in a study. Methods like analysis of complaints, anamnesis data, objective examination, laboratory and instrumental methods of investigation were used to diagnose BP. Results. The study of cytokine status in patients with BP in the presence of purulent cholangitis against a background of conservative therapy revealed an increase in the concentration of the blood plasma TNF-a, IL-6 and IL-8 in first 3-4 days, and a decrease ofIL on 4-7 days after the surgery. The combination of minimally invasive interventions with conservative therapy effectively reduced levels of TNF-a, IL-4, and IL-6 in the bile of patients with BP. Comparing with the preoperative period the concentration of TNF-a, IL-4 and IL-6 in bile were significantly less at 71.0%, 47.7%, and 70.6% respectively. In order to predict the risk of BP development, the method of endoscopic ultrasonography was developed. In 96% of the cases, this method confirmed the presence of BP. In the postoperative period after the combined minimally invasive interventions against the background of the therapy, at the first 3 days, the improvement of the condition was noted in all 60 patients. The average bed-day was 8.4 ± 1.2 days, in comparison with the patients in the second group with 26.6 ± 2.4 days. The postoperative complication was noted in 5 (8.3%) patients, in contrast to 12 (18.2%) in the group of patients after traditional operations. Two (3.0%) patients died after the traditional operation from the progressive multi-organ failure. Conclusion. Modern laboratory and instrumental research methods can predict complications of biliary pancreatitis. Combined minimally invasive interventions allow improving the immediate results of BP treatment.

biliary pancreatitis, cytokine status, endoscopic ultrasonography, combination of minimally invasive interventions

1. Воробей А.В. и др. Выбор метода хирургического лечения хронического панкреатита // Вестник хирургии. - 2014. - Т.173, № 5. - С. 36-43.

2. Дибиров М. Д., Багненко С. Ф., Благовестнов Д. А. и др. Диагностика и лечение острого панкреатита. Российские клинические рекомендации (Экспертная группа Российского общества хирургов по проблемам острого панкреатита).- СПб., 2014. - 32 с.

3. Дмитриев А.В. Особенности лечебно-диагностической тактики при билиарном панкреатите // Соврем. проблемы науки и образования. - 2014. - № 4. - С. 282.

4. Anderloni A., Repici A.Role and timing of endoscopy in acute biliary pancreatitis. World journal of gastroenterology, 2015, Vol. 21, No. 40, pp. 11205-11208.

5. Nesvaderani M. et all. Epidemiology, aetiology and outcomes of acute pancreatitis: A retrospective cohort study. International journal of surgery, 2015, Vol. 23, Pt. A, pp. 68-74.