Хірургічне лікування хворих з гострим біліарним панкреатитом та жовчною гіпертензією

Abstract

Objective. To improve the results of treatment in patients, suffering an acute biliary pancreatitis with biliary hypertension, applying individual approach in choosing surgical procedure in early phase of the disease.

Маterials and methods. The results of diagnosis and treatment of 140 patients, suffering an acute biliary pancreatitis, were analyzed. There were 33 men and 107 women, ageing 22 – 88 yrs, and median age – 57.6 yrs old. In all the patients biliary origin of pancreatitis was diagnosed in accordance to criteria, proposed by Holland’s Investigation Group for Pancreatitis Studying. The patients were divided into two groups, in accordance to periods for conduction of decompressive treatment procedures. Into Group 1 were included 70 patients, in whom decompressive surgical interventions were performed in the first 72 h after primary appearance of abdominal pain, independent from time of admittance to the clinic, and into Group 2 – 70 patients, in whom the wait–and–see tactics with conservative therapy was applied in accordance to the disease severity, decompressive methods were used later than 72 h after the disease beginning.

Results. In patients of Group1 49 fibrogastroduodenoscopies (FGDS) with papillosphincterotomy and lithoextraction, 10 transcutaneous puncture drainages, 13 laparoscopic cholecystectomies with external draining of extrahepatic biliary ducts (in 5 patients laparoscopic choledochoscopy with lithoextraction) were performed. Necrotic forms of an acute pancreatitis were revealed in 26 (37.1%) patients, in 12 (46.2%) of them the infectioning have occurred. Average duration of treatment have constituted 15.48 days, and lethality – 8.57%. In patients of Group 2 22 FGDS with papillosphincterotomy and lithoextraction,5 transcutaneous puncture drainages, 6 cholecystectomies (of them 5 – with external draining of common biliary duct), 18 necrsequestrectomies (in 11 patients cholecystectomy was done additionally and in 7 – drainage of extrahepatic biliary ducts) were performed. Necrotic forms of an acute pancreatitis have developed in 38 (54.3%) patients, of them in 25 (65.8%) the infectioning have occurred. Average duration of treatment have constituted 22.2 days, and lethality – 17.14%.

Conclusion. Application of decompressive operative interventions for elimination of biliary hypertension in patients, suffering an acute biliary pancreatitis in the first 72 h after the disease beginning, make possible to reduce the occurrence rate for necrotic and infected forms, the disease severity, the lethality level and the stationary state duration.