SURGICAL PREVENTION OF COMPLICATIONS FOLLOWING PANCREATIC RESECTION IN CHRONIC PANCREATITIS
The aim of the investigation is to study complications after different variants of pancreatic resections in patients with chronic pancreatitis (CP), to identify their causes, to offer surgical methods of their prevention and treatment. Material and methods. Fourty two patients (25 (59.5%) men and 17 (40.5%) women) having CP underwent different options of pancreatectomy. Their mean age was (48.6 ± 4.0) years. Acute pancreatitis history was registered in 16 (38.1%) patients, pancreonecrosis with subsequent surgical treatment underwent 10 (38%) patients. Five 5 (11.9%) patients showed signs of biliary hypertension, one of them at the stage of the Municipal Hospital underwent holecystoenteoanastomosis, one patient underwent cholecystectomy with external drainage of common bile duct. Three patients had mechanical jaundice at admission. Pancreatoduodenectomies (PDR) were performed in 13 (31%) patients, distal pancreatectomy underwent 17 (40.5%) patients: 8 (19%) with pancreatoenteroanastomosis, 9 (21%) with the stump suturing pancreas, 9 (21%) with spleen preservation. Central resection was performed in 12 (28.5%) patients. Results. Complications of the PDR occurred in 11 (84.6%) patients, after failure of pancreatoenteroanastomosis PDR occurred in 2 (15.3%) patients. Abscess in pancreatoenteoanastomosis zone and subhepatic space was diagnosed in 9 (69.2%) patients. Massive intraoperative bleeding occurred in 3 (23.1%) patients. Formation of № 4 (59) декабрь’2016 Вопросы реконструктивной и пластической хирургии В помощь практическому врачу 53 fistulas after the surgery was in 2 (15.3%), all fistulas closed yourself after the surgery. Abscesses and fluid accumulations after distal resection were in 5 (29.4%) patients. Pleurisy developed in only 1 (5.8%) patient. Patients operated on using the proposed new technology of pancreatoenteroanastomosis did not demonstrate any failure. Conclusions. Thus, using the proposed technology of surgical prevention allowed to reduce incidence of failures after pancreatoenteroanastomosis in PDR performing and to reduce number of abscesses and fluid accumulation in distal resection of pancreas.
Keywords
хронический панкреатит,
операция Фрея,
панкреатодуоденальная резекция,
несостоятельность панкреатокишечного анастомоза,
chronic pancreatitis,
pancreatoduodenal resection,
the Fray surgery,
pancreatoenteroanastomosis incompe tence,
distal resectionAuthors
| Lubyansky V.G. | | |
| Arguchinsky I.V. | | |
| Seroshtanov V.V. | | basner89@mail.ru |
Всего: 3
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