Features of Pathogenetic Approach to the Treatment of Acute Necrotizing Pancreatitis

A.I. Dronov, I.A. Kovalskaya, V.Yu. Uvarov, A.I. Gorlach

Abstract


Objective: to determine the significant elements in pathogenesis of acute necrotizing pancreatitis, which define the set of necessary medical measures.
Material and Methods. The study involved 1197 patients with severe acute necrotizing pancreatitis. There were formed 2 comparison groups: 509 patients (control group) treated from 2003 to 2007, and 688 patients (experimental group) — from 2008 to 2012. The groups were identical in terms of sex and age. The diagnostic and treatment algorithm in view of acute necrotizing pancreatitis pathogenesis specific features and with the use of minimally invasive technologies were developed in the clinics and applied to the experimental group. The research revealed that different tactics should be applied to the each stage of disease. In the early stage — strictly conservative approach with the usage of efferent detoxification methods and «abortive» therapy, in late — non-invasive, and with the signs of infection — active-surgical.
Results. Suggested diagnostic and therapeutic program with the use of minimally invasive technologies in accordance with acute necrotizing pancreatitis pathogenesis facilitated the reduction in the number of surgical interventions by 9.8 % (control group — 28.3 %; experimental — 18.5 %); mortality indicators stabilization within 9.6–11.8 % in the patients’ group with severe acute necrotic pancreatitis; reduction of the hospital stay duration by 7.1 days.
Conclusions. There is no gold standard of acute necrotizing pancreatitis treatment; the treatment should be complex and individual. The fundamental treatment issues are the pathogenetic disease features consideration, the phasing of disease course and providing pathogenetically grounded treatment in every period of the disease.


Keywords


severe acute necrotizing pancreatitis; pathogenesis; multimodality treatment

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DOI: https://doi.org/10.22141/1997-2938.3.22.2013.87420

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