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1 Отделение панкреатологии, городской панкреатологический центр ГБУ "Санкт-Петербургский научно-исследовательский институт скорой помощи им. И.И. Джанелидзе"; 192242, Санкт-Петербург, ул. Будапештская, д. 3, Российская Федерация 2 Кафедра военно-морской и госпитальной хирургии ФГБВОУ ВПО "Военно-медицинская академия им. С.М. Кирова" МО РФ; 194044, Санкт-Петербург, ул. Академика Лебедева, д. 6, Российская Федерация Ïîäaeåëóäî÷íàÿ aeåëåçàЦель. Разработка более эффективных методов хирургического лечения больных гнойно-некротическим парапанкреатитом. Материал и методы. Были проанализированы результаты лечения 819 больных гнойно-некротическим парапанкреатитом. Объем панкреонекроза и степень распространенности гнойно-некротического парапанкреатита определяли при КТ-ангиографии или МРТ, а также во время хирургических вмешательств или при аутопсии. Проведено сравнение различных методов хирургического лечения в зависимости от сроков и вида оперативного лечения. Эффективность оценивали по частоте развития осложнений, тяжелого сепсиса и летальности. Заключение. Методом выбора в лечении гнойно-некротического парапанкреатита является минимально инвазивное дренирование под лучевым наведением с поэтапной заменой дренажей на больший диаметр с последующей аспирационной и (или) инструментальной некрсеквестрэктомией. При неэффективности миниинвазивных вмешательств необходимо выполнять лапаротомию с некрсеквестрэктомией. поджелудочная железа, панкреатит, панкреонекроз, парапанкреатит, минимально инвазивные технологии, дренирование. Aim. To develop more effective methods of surgical treatment of patients with purulent-necrotic parapancreatitis. Material and Methods. Treatment of 819 patients with purulent-necrotic parapancreatitis was analyzed. The volume of pancreatic necrosis and extent of purulent-necrotic parapancreatitis were determined according to multispiral computed tomographic angiography or magnetic resonance imaging, as well as during surgery or autopsy. Different surgical methods were compared depending on time and type of surgery. Effectiveness was estimated according to incidence of complications, severe sepsis and mortality rate. Conclusion. Minimally invasive drainage under x-ray guidance with step-by-step replacement of drains to larger diameter followed by aspiration and/or instrumental necrosectomy is preferable in treatment of purulent-necrotic parapancreatitis. Laparotomy with necrosectomy are ad-visable if minimally invasive procedures are ineffective. Клю че вые сло ва:

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Introduction. In megacities, the use of organs obtained from those who died as a result of sudden out-of-hospital cardiac arrest (OHCA) for transplantation is one of the promising ways of addressing the problem of organ donor shortage. In St. Petersburg, the model of transition from life support via extracorporeal membrane oxygenation (ECMO) of patients after OHCA to ECMO life support for organs of potential donors was tested for the first time.Materials and methods. In order to implement the program, round-the-clock ECMO and transplantation teams were organized at the inpatient emergency ward of Pavlov First St. Petersburg State Medical University. Interaction with the St. Petersburg City Emergency Station, St. Petersburg was established. The protocol of work with potential donors brought to the hospital after a sudden circulatory arrest was developed, approved by the ethics committee, and implemented in clinical practice. This was the first in Russia and in international practice. Between 2017 and 2020, 67 patients with sudden OHCA were brought to the inpatient emergency ward. In 4 (5.97%) cases, advanced cardiovascular life support was successful, and 11 (16.42%) patients became effective donors. Mortality among this group of patients without subsequent postmortem donation was 77.61% (52 patients).Results. Liver transplantation from non-heart-beating donors (NHBDs) whose blood circulation was restored by ECMO (ECMO NHBD) was performed in 5 recipients who were in severe condition against the background of liver failure. In 1 (20%) case, there was severe liver allograft dysfunction for 33 days with subsequent complete restoration of function. Kidney transplantation was performed in 22 patients. Immediate graft function occurred in 10 (45.45%), while delayed function occurred in 12 (54.55%) patients. Kidney graft survival was 86.4%, kidney graft recipient survival was 95.5%, liver graft recipient survival was 80%, and the follow-up period was 24.1 ± 7.15 months.Conclusion. The use of ECMO to save the lives of patients with sudden OHCA can be implemented in conditions of a high degree of organization and synchronization of the work of the city emergency medical station and the emergency department of a multidisciplinary hospital. If cardiopulmonary resuscitation with ECMO (ECMO CPR) fails, it is possible to launch the ECMO NHBD donor program. Long-term outcomes of liver and kidney transplantation from ECMO NHBD are consistent with those using organs from brain-dead donors. Widespread implementation of the new organ donation model will increase the availability of transplant care.

Государственное бюджетное учреждение «Санкт-Петербургский научно-исследовательский институт скорой помощи имени И. И. Джанелидзе»,