МЕХАНИЗМЫ ФОРМИРОВАНИЯ ПОСТНЕКРОТИЧЕСКИХ КИСТ ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ, СРОКИ И МЕТОДЫ ЭНДОСКОПИЧЕСКОГО ЧРЕЗЖЕЛУДОЧНОГО ДРЕНИРОВАНИЯ 1 ФГБОУ ВО «Алтайский государственный медицинский университет» Минздрава России, Барнаул, Россия 2 КГБУЗ «Краевая клиническая больница», Барнаул, Россия Изучены результаты эндоскопического чрезжелудочного дренирования жидкостных скоплений и постнекротических кист поджелудочной железы у 34 больных. По данным гистологического исследования участков ткани поджелудочной железы и парапанкреальной клетчатки изучены особенности формирования постнекротических кист поджелудочной железы. Исследованы результаты и вероятные причины осложнений, разработана технология чрезжелудочного дренирования и ведения послеоперационного дренирования. Ключевые слова: поджелудочная железа, панкреонекроз, постнекротическая киста, эндоскопическая ультрасонография, цистогастроанастомозThe results of endoscopic stomach drainage of fluid aggregates and post-necrotic pancreatic cysts have been investigated in 34 patients. All the patients were divided into two groups. The first group included early stage patients (from the onset of the disease up to 6 weeks duration), the second group covering the period post 6 weeks. According to the findings of the histological examination of pancreatic site tissue and peripancreatic fiber specific features of forming post-necrotic pancreatic cysts at early and late stages from the beginning of the disease have been studied by means of the endoscopic ultrasound technology. Besides, the stages of post-necrotic pancreatic cyst formation have been explored. The technology of through-the-stomach drainage has been developed, including the cyst puncture at the initial phase as well as subsequent dissection of the stomach wall and the cyst with the cystotome and its emptying. In the postoperative period balloon dilation of the cystogastroanastomosis and stage sanitations were carried out. If necessary, necrectomy with stent application was performed. Draining time parameters have been determined depending on the capsule formation, which consists of the early fibrinous layers and granulation tissue and subsequently turns into the fibrous membrane 3.4 mm thick.The study of the results of operations and the analysis of the causes of complications have been conducted, gastric bleeding being the most dangerous complication registered in 3 patients. To prevent intraoperative bleeding the method of post-necrotic cyst drainage has been changed.

The aim: To analyze results of surgical treatment of patients with chronic pancreatitis (CP) and to assess the causes of pancreatic cancer after surgical treatment. Materials and methods: 137 patients had duodenum-preserving resections of the pancreas. Results: In the histological examination of the pancreas it was established that the growth of fibrous tissue was registered in patients with CP., which in 19 (13.8%) almost completely replaced the acinar tissue. In the long term after the operation from 6 months to 2 years in 8 patients (5.8%) pancreatic cancer was detected. Possible causes of tumor origin were analyzed, the value of preservation of ductal hypertension, which affects the state of the duct’s epithelium, was established. The most commonly used for treatment of chronic pancreatitis the Frey surgery removed pancreatic hypertension but in two patients during the operation an insufficient volume of the pancreatic head was reconstructed. In the case of the abandonment of a large array of fibrous tissue, local hypertension was retained in the region of the ductal structures of the head, which led to the transformation of the duct epithelium. An essential factor in the problem of the preservation of pancreatic hypertension were the stenosis of pancreatic intestinal anastomoses, they arose in the long term in 4 operated patients. With stenosis of anastomosis after duodenum-preserving resection both the hypertension factor and the regeneration factor could be realized, which under certain circumstances might be significant. Conclusion: After resection of the pancreas for CP cancer was diagnosed in 5.8% of patients. The main method of preventing the risk of cancer was performing the Frey surgery for CP eliminating pancreatic hypertension in the head region of the pancreas. Diagnosis of stenosis in the late period after resection of the pancreas was an important element in the prevention of recurrence of cancer since a timely reconstructive operation could improve the drainage of duct structures.

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ВВЕДЕНИЕПроблема панкреонекроза (ПН) является актуаль-ной в связи с высокой заболеваемостью и летально-стью, которая колеблется от 21 % до 85 % [1,7,11, 12,13]. Неудовлетворительные результаты хирургическо-го лечения, как правило, связаны с распространением