In the past decades, mortality in acute pancreatitis ranges from 3 to 15 % and depends mainly on the specific weight of severe forms of morbidity, which is characterized by the development of necrotic processes in the pancreas and systemic complications. Despite the large number of studies on severe forms of acute pancreatitis, a significant improvement of results of treatment of this category of patients is not observed. The integrated diagnosis and treatment of this pathology, prognosis and prevention of purulentseptic complications are relevant today. The aim of the study was to evaluate the effectiveness of surgical tactics depending on the nature and prevalence of local purulent-septic complications of acute pancreatitis. To solve this problem, the results of treatment were analyzed the results of treatment of 422 patients with acute pancreatitis who were treated in the surgical Department of the Poltava regional clinical hospital in the period from 2010 to 2015. All patients were admitted to hospital for 1-7 days after infection. 315 (74.6 %) of them are diagnosed as having acute pancreatitis easy, patients received conservative therapy and 7-10 days was discharged from the hospital. Moderate and severe pancreatitis with the development of local parapancreatic complications were diagnosed in 107 patients (25, 4%), 67 (62.6%) men and 40 (37, 4%) women. Their age ranged from 22 to 81 years (47, 9±1.5 years). The severity of the patients was determined by the BISAP scale, the presence of organ failure was diagnosed by applying the Marshal scale (modification 2012) [5]. The patients were examined according to the order Ministry of Healthcare of Ukraine № 297 dated 2 April 2010. Moderate acute pancreatitis is characterized by localization of purulent-septic complications in 12 anatomical areas with a predominantly liquid component. Severe acute pancreatitis is characterized by the localization of purulent-septic complications in more than 2 anatomical sites with primarily tissular component. Efficacy of simple drainage procedures depended on the incidence of fluid accumulations in the 1-2 anatomical region and presence of a predominantly liquid component. Among the patients with predominant tissue component in the liquid accumulation and the prevalence of local parapancreatic complications in more than two anatomic sites, the performance of open necrosectomy seems to be the most appropriate.

Fluid accumulation in the peri-pancreatic region and the distal areas of the abdominal cavity is widespread in the early stage of acute severe pancreatitis. The fluid is mainly hemorrhagic ascites, rich in activated lipolytic and proteolytic enzymes, vasoactive substances and inflammatory cytokines, and is aseptic at the onset of the disease. Evacuation of a fluid rich in potentially toxic mediators from the abdominal cavity is supported in a number of publications as a rational measure to alleviate the burden of disease in critically ill patients.The purpose of the study was to analyze recent publications on surgical tactics for enzymatic peritonitis and its impact on acute severe pancreatitis.A thorough analysis of the literature made it possible to draw the following conclusions related to the state of this problem. To date, randomized clinical trials and publications show controversial data on the efficacy of surgical interventions for acute pancreatitis complicated by ascites-peritonitis. International recommendations have a low level of evidence regarding the effectiveness of drainage, lavage and video-laparoscopic rehabilitation due to inclusion of patients with non-severe pancreatitis into individual Українська медична стоматологічна академія, м. Полтава, Україна A -концепція та дизайн дослідження; B -збір даних; C -аналіз та інтерпретація даних; D -написання статті; E -редагування статті; F -остаточне затвердження статті Накопичення рідини в перипанкреатичній області та віддалених ділянках черевної порожнини поширене на ранній стадії гострого тяжкого панкреатиту. Рідина найчастіше є геморагічним асцитом, багата активованими ліполітичними і протеолітичними ферментами, вазоактивними речовинами та запальними цитокінами, на початку захворювання асептична. Евакуація з черевної порожнини рідини, багатої на потенційно токсичні медіатори, в низці публікацій описана як раціональний захід для полегшення страждань хворих у критичному стані.Мета роботи -проаналізувати публікації останніх років щодо хірургічної тактики при ферментативному асцит-перитоніті та її впливу на перебіг гострого тяжкого панкреатиту.Висновки. Рандомізовані клінічні дослідження і публікації демонструють суперечливі дані щодо ефективності хірургічних утручань при гострому панкреатиті, що ускладнений асцит-перитонітом. Міжнародні рекомендації мають низький рівень доказовості щодо ефективності дренування, лаважу та відеолапароскопічної санації, який пов'язаний із залученням в окремі дослідження пацієнтів із нетяжким панкреатитом. Оптимізація хірургічної тактики в пацієнтів з асцит-перитонітом при тяжкому панкреатиті може бути пов'язана з визначенням тяжкості стану пацієнта з асцит-перитонітом, вираженості парапанкреатиту, рівня токсичності асцит-перитоніту, показань та оптимального часу дренування/лаважу. Для розв'язання цих питань необхідно продовжити проспективні дослідження.Хирургическая тактика при остром панкреатите, осложненном асцит-перитонитом В. В. Касьян, О. Ю. Черкун, Д. А. Сытник, В. Д. Шейко Накопление жидкости в перипанкреатической ...

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Acute pancreatitis (GP) is one of the most common diseases of the digestive system requiring urgent hospitalization, and there is a global tendency to increase the incidence of this disease. In recent years, approaches to the classification of this disease have been revised. The purpose of this work was to analyze recent year publications regarding modern views on the diagnosis, identification and prediction of the severity of acute pancreatitis. The study was based on the search of relevant information in peer-reviewed journals through the "Medline" sources over the past 5 years by key words as acute severe pancreatitis, classification. The data obtained were then carefully analyzed. Modern views on the diagnosis of severe forms of acute pancreatitis are based on the new international classifications of RAC and DBC. The presence of organ failure and its duration is a key criterion for the diagnosis of acute severe pancreatitis. In addition to organ failure, DBC recommends the use of pancreatic necrosis and its sterility / infectivity, which is more relevant for the late phase of the disease. Early diagnosis and prediction of multiple organ failure are of great significance in planning and correction of intensive care, and the diagnosis of parapancreatic complications is exceptionally important for choosing the proper surgical tactics. The correct evaluation of the classification data in the dynamics will determine the extent and staging of surgical interventions. The development and grounding of an optimal approach to the treatment of acute severe pancreatitis based on key classification features is to minimize the adverse effects.