Objective. Estimation of variants of the pancreatic gland pathology and rate of the unfavorable results occurrence in late postoperative period in patients, suffering  complicated forms of chronic pancreatitis, depending on the procedures of surgical treatment. Materials and methods. Results of surgical treatment of complicated forms of chronic pancreatitis in department of the gut surgery in 2007 - 2017 yrs were studied in 107 patients, who were divided into two groups: the Group I – 67 (62.7%) patients, in whom pancreato- and virsungodigestive operations were performed, and the Group II – 40 (37.4%) patients, in whom duodenum—preserving resection-drainage surgical interventions were done. Results. Unfavorable variants of pancreatic pathology were observed significantly more frequently in patients of the Group I – in 34/67 (50.7%) in comparison with patients of the Group II – in 6/40 (15.0%) (χ2=9.49, p=0.002). Conclusion. Analysis of rate of the unfavorable results occurrence in late postoperative period, depending on surgical tactics appled, have shown a trustworthy advantage of the resection-drainage operations.

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The aim of the study. Assessment of markers of early complications in patients with acute pancreatitis. Materials and methods. Observation was carried out for 151 patients who were in the clinic from 2011 to 2019, with a diagnosis of acute pancreatitis (OP). The average age of patients (47.8±1.5) years. The patients were divided into 2 groups: group I -78 patients with developing pancreatic pseudocyst (PP) and group II -73 patients with free fl uid accumulations (FFA) of the abdominal cavity. All patients underwent comprehensive examinations, including histology of emerging cysts, clinical and biochemical blood tests, sonography and computed tomography, bacteriological and enzyme immunoassays with assessment of the level of endogenous intoxication, procalcitonin, microbial contamination and cytokines.Results. In comparison with group I patients with developing PP, the observed group II patients with FFA showed a significant increase in the degree of endogenous intoxication. A 3.0-fold increase in the level of procalcitonin in 26.8% of group I patients and in 67.1% of group II patients (p<0.05) with a directly proportional dependence of this indicator on the level of bacterial contamination (r=+0.51; p<0.05) indicated the activation of infection processes in general and, to a greater extent, in group II patients. At the same time, the condition of their last worsened due to the transition of the infl ammatory process to the parapancreatic region and into the retroperitoneal space. The high level of proinfl ammatory cytokines IL-6, TNF-α in patients of group II compared with group I, an imbalance and a decrease in the activity of the anti-infl ammatory mediator IL-10 determined a signifi cantly greater (p<0.05) activity of the infl ammatory process in patients with SFS, and were associated with an unfavorable prognosis. Conclusion.The formation of a PP is a relatively favorable outcome of acute pancreatitis, accompanied by signifi cantly less pronounced toxemia and infection rate in comparison with patients with free fl uid accumulations of the abdominal cavity.

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The purpose of the study was to identify the patterns of changes in the state of the parenchyma of the pancreas in patients with complicated forms of chronic pancreatitis with evaluation of the diagnostic effectiveness of shear wave elastometry (graphy). Materials and methods. For the period from 2006 to 2018 58 patients with complicated forms of chronic pancreatitis were examined. The average age of patients is (47.1±3.2) years old. The medical history ranged from 3 to 15 years. The basis of morphological studies were biopsies of the pancreas obtained during surgery. Ultrasound elastometry and pancreatic parenchymal elastography were performed by transcutaneous shear wave approach in Shear Wave Elastography. Software consistency was assessed by the nature of the color mapping. Results and discussion. The morphometry of the volume parts of the structural components of the pancreas showed that with the development of complicated chronic pancreatitis there is an increase in the area of fibrous tissue and a decrease in the area of acinar components. The proof of this is the strong inverse relationship between the degree of fibrosis and the volume fraction of acinar tissue (r= -0.83; р <0.05), as well as the direct relationship between the degree of fibrosis and the volume fraction of connective tissue (r=0.61; р <0.05). If at a fibrosis of the III degree acinar tissue occupied (25.39±2.01)%, connective – (64.33±3.85)%, fatty – (6.42±4.48)%, at a fibrosis of the IV degree noted the following: the proportion of acinar tissue was only (2.86±0.76)%, connective – (74.11±4.17)%, and (20.14±4.29)% was adipose tissue. Such manifestations indicated severe irreversible changes in the external secretory function of the pancreas. When assessing changes in the stiffness of the pancreatic parenchyma with the deepening of fibrosis processes and data from transcutaneous shear wave elastography, it was found that the degree of fibrosis according to morphological data correlated with the degree of fibrosis according to shear wave elastography, r = 0.71; p <0.05. The following patterns were noted. Grade II pancreatic fibrosis was characterized by intralobular fibrosis, which covered 26-50% of the gland area, which corresponded to the shear wave elastography data in green-blue color (5.98-7.05 kPa). Grade III pancreatic fibrosis corresponded to intralobular fibrosis, which covered 51-75% of the gland area in shear wave elastography in green-yellow color (7.06-9.06 kPa). Grade IV pancreatic fibrosis was characterized by intralobular fibrosis, which covered 76-100% of the gland area, which corresponded to shear wave elastography data in yellow-red color (> 9.07 kPa). Conclusion. Thus, the objectification of shear wave elastography indicators of the pancreas based on the correlation of histological evaluation and morphometric indicators of structural changes in the pathological process allows to consider transcutaneous shear wave elastography as a promising and reliable method of non-invasive diagnosis of fibrosis in chronic pancreatitis