IMPROVING TECHNOLOGIES FOR PREDICTING THE COURSE, DIAGNOSTIC AND TREATMENT OF COMPLICATIONS OF ACUTE PANCREATITIS

Abstract

A feature of acute pancreatitis is the high risk of developing complications, the mortality rate of which reaches 15%, and in severe cases it ranges from 40 to 70%. At the same time, timely determination of the severity of the disease, identification of risks and early diagnosis of complications significantly improve treatment results. The purpose of the study was to improve the results of treatment of patients with acute pancreatitis by developing pathogenetically based methods for predicting the course, early diagnosis of complications of the disease and improving their treatment. The study was based on the results of examination of 280 patients with severe acute pancreatitis, who were divided into two groups: a comparison group – patients who used traditional methods of examination and treatment (n=139) and the main group – patients who used improved surgical tactics (n =141). To assess the effectiveness of surgical tactics in the studied groups, a comparative analysis of the applied methods, the frequency of postoperative complications, mortality, and the duration of hospitalization was carried out. The use of the improved technology of enteral tube feeding in patients with a severe course of acute pancreatitis reliably improves biochemical indicators of blood serum and reduces the frequency of intolerance to nutritional support in the first 7 days of treatment by 19.7% (χ2=10.1, 95% CI 7.62- 31.25, p=0.001). The implementation of the proposed staged approach in the treatment of intra-abdominal hypertension makes it possible to obtain a probable decrease in the level of intra-abdominal pressure already 48 hours after the start of treatment (16.4 ± 3.1 and 14.9 ± 3.1 mm Hg, p<0.05 respectively) and improve treatment outcomes by reducing the incidence of infected local complications by 27.3% (χ2=8.12, 95% CI 8.61-43.46, p=0.004). Improvement of endoscopic treatment methods for patients with acute biliary pancreatitis makes it possible to reliably reduce the frequency of postoperative complications in this category of patients by 19% (χ2=6.47, 95% CI 4.24-34.71, p=0.01) and obtain a tendency to decrease mortality by 2.7% (χ2=1.05, 95% CI -6.53-13.82, p=0.3). The use of the proposed diagnostic and treatment technologies likely reduces the duration of hospitalization of patients by 11.1 days (p=0.0002), the frequency of extra-abdominal complications – by 16.9% (p=0.008), life-threatening postoperative complications (grade V according to Clavien-Dindo classification) – by 13.9% (p=0.01), overall mortality – by 8% (p=0.01), postoperative mortality – by 13.9% (p=0.01).