Risk factors of development complications and death in patients with acute non-biliary necrotizing pancreatitis

Abstract

Introduction. Treatment of patients with acute pancreatitis, still, one of the most actual and complex problems in emergency surgery of the abdominal cavity. The biggest difficulty is the treatment of complicated forms of acute necrotizing pancreatitis. These patients have the highest mortality rates. The aim of the study. Determine risk factors for development complications and death in patients with acute necrotizing pancreatitis. Materials and methods. The results of surgical treatment of 746 patients with acute necrotizing pancreatitis were analyzed. In 63 patients, as the main treatment method was performed early laparotomy (in the aseptic phase of the inflammatory process), expectant tactic were used in 72 patients– surgical interventions were performed in cases of development purulent complications (laparotomy was the main intervention), in 273 patients with acute not biliary infected necrotizing pancreatitis, underwent puncture-drainage operations under ultrasound control and lumbotomy, and in 338 patients similar surgical procedures were performed, but in cases of acute not biliary aseptic necrotizing pancreatitis. Results and discussion. The analysis of the obtained data made it possible to identify a number of risk factors for the development of complications and death in cases of acute necrotizing pancreatitis. These include: the duration of the disease, the prevalence of the inflammatory process in the pancreas and the surrounding tissue spaces, the involvement of retroperitoneal tissue in the inflammatory process, the combination of abscess of the omentum bag and phlegmon of retroperitoneal tissue, enzymatic peritonitis, expectant tactic, when surgical interventions are performed in the development of purulent complications of acute necrotizing pancreatitis, early laparotomy in the aseptic phase of the inflammatory process. Conclusions. Treatment tactics in patients with acute necrotizing pancreatitis must necessarily take into account the risk factors for the development of complications and death, and should also be aimed, first of all, on the preventing purulent complications. When choosing the method and scope of surgical intervention, preference should be given to puncture-drainage operations under ultrasound control and direct surgical interventions on retroperitoneal tissue from mini-accesses (extraperitoneal access) – lumbotomy, which is determined by the localization and characteristics of the fluid collection.