Purulent-Necrotic Parapancreatitis: the Evolution of Views on Treatment

Goltsov, V. R.; Savello, V. E.; Bakunov, A. M.; Дымников, Д А; Kurochkin, D. M.; Batig, E. V.

doi:10.16931/1995-5464.2015375-83

Cited by 11 publications

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“…It is characterized by a body response to the formed necrotic foci (both in the pancreas and parapancreatic cellular tissue). Clinically, phenomena of resorptive fever prevail, peripancreatic infiltrate is being formed [ 1 , 14 , 15 , 17 , 18 ].…”

Section: Appropriateness Of Using Hemofiltration In Patients With Severe Acute Pancreatitismentioning

confidence: 99%

Hemofiltration in Patients with Severe Acute Pancreatitis (Review)

et al. 2020

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Questions regarding the application of extracorporeal detoxification to patients with severe acute pancreatitis have been considered. Hemodialysis, the historically first method of extracorporeal detoxification for such patients, has been also described in the review. Appropriateness of using renal replacement therapy methods and among them continued renal replacement therapy has been shown. Hemofiltration and hemodiafiltration technologies are described in detail including different modes of their application and the possibility of using various types of filters. Available data on hemofiltration for patients with severe acute pancreatitis have been analyzed. Great attention is paid to the unsolved aspects of hemofiltration in severe acute pancreatitis such as determining renal and extrarenal indices; time of starting hemofiltration; selection of volume replacement modes and a buffer system; procedure duration; anticoagulation measures, defining criteria to assess the adequacy of hemofiltration, state severity, and organ dysfunction degree. Further multicenter investigations are necessary to be able to assess the efficacy of the hemofiltration procedures on the basis of the thoroughly worked out and pathogenically grounded protocol using adequate control methods taking into consideration endogenic intoxication phases and intensity of the multiple organ failure syndrome.

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Section: Appropriateness Of Using Hemofiltration In Patients With Severe Acute Pancreatitismentioning

confidence: 99%

Hemofiltration in Patients with Severe Acute Pancreatitis (Review)

et al. 2020

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“…Ефективність цих методик становить приблизно 50-60% з рівнем ускладнень 30-40% та летальністю 10% [3]. Зважаючи на це, останнім часом з'явилися дослідження, присвячені етапному підходу до лікування («step-up approach») [1]. Однак слід зазначити, що місце міні-інвазивних втручань при інфікованому панкреонекрозі потребує уточнення, також існує багато чинників, які не дозволяють порівняти ефективність використовуваних методик (різні діагностичні підходи, невелике число спостережень у групах дослідження, різна тяжкість захворювання і супутньої патології, різний досвід оперуючих хірургів).…”

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Stage approach in surgical treatment of acute pancreatitis.

Kolosovych¹,

Безродный²,

Hanol³

et al. 2020

Medicni Perspektivi (Medical Perspectives)

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”Fulminant” acute pancreatitis: diagnosis, prognosis, treatment

Корымасов

Хорошилов

2021

Ann. hir. gepatol.

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Aim: improving the results treatment of patients with severe acute pancreatitis by early diagnosis fulminant course of the disease and development of individualized treatment tactics based on early surgical interventions with perioperative extracorporeal detoxificationMaterials and methods: In research analyzed the treatment of 232 patients with severe acute pancreatitis: 175 patients were evaluated retrospectively (control group), 57 were included in a prospective study (main group). The severity of the disease was studied using integral scales, necrosis of the pancreas (its localization, depth) and the prevalence of parapancreatitis (gradations according to Ishikawa et al.) - according to CT data. The tactics of treatment at the retrospective stage of the study was based on the current Clinical Recommendations, at the prospective stage - on the developed signs of a "fulminant" course of the disease and included early operations with perioperative extracorporeal detoxification.Results: Criteria for a fulminant course of severe acute pancreatitis were found in 41 (23%) of 175 and 24 (42%) of 57 patients. According to the scale values (APACHE II ≥ 16 Ranson ≥ 8, SOFA ≥ 7 points) in the first 48 hours from the onset of the disease, the presence of aseptic enzymatic peritonitis, the depth of necrosis in the region of the head and body of the pancreas ≥50%, intra-abdominal hypertension of the III-IV degree, significant differences with similar indicators in 134 and 33 patients with severe acute pancreatitis. With fulminant course in the control and main groups, all 5 patients who received only conservative treatment died, 33 (86.8%) and 9 (40.9%) after operations, χ2 = 13.32, p<0.001. Mortality in severe acute pancreatitis, excluding patients with fulminant course, was comparable in the groups, being 15.7% and 15.2%, χ2 = 0.450, p> 0.05.Conclusion: Patients with severe acute pancreatitis represent a heterogeneous group. The morphological substrate of "fulminant" pancreatitis is deep (more than 50%) necrosis with localization in the head and body of the pancreas and widespread parapancreatitis. The developed individualized approach to treatment allows predicting an unfavorable course in the first 48 hours after the onset of the disease. Early operations in the nature of detoxification, decompression and drainage interventions, with perioperative use of extracorporeal detoxification methods allowed to reduce mortality from 86.8% to 40.9%.

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Purulent-Necrotic Parapancreatitis: the Evolution of Views on Treatment

Cited by 11 publications

References 0 publications

Hemofiltration in Patients with Severe Acute Pancreatitis (Review)

Hemofiltration in Patients with Severe Acute Pancreatitis (Review)

Stage approach in surgical treatment of acute pancreatitis.

”Fulminant” acute pancreatitis: diagnosis, prognosis, treatment

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