Abstract: Purpose. Define the role of ultrasound diagnostics in preoperative evaluation, surgical approach, and postsurgical assessment in patients with cystous lesions of pancreas underwent various types of pancreatic distal resection (PDR). Material and methods. Since 1995 till 2008 in Vishnevsky Institute of Surgery (Moscow) 54 patients with distal cystous lesions of pancreas received a course of treatment. Mean age was 50,6+1,2 years, 37 patients (68.5%) were women. Complex pre- and postoperative ultrasound study was performed in all the cases. Morphologically there were true cysts (2 cases), lymphocysts (1 case), postnecrotic cysts (21 patients), serous cystadenoma (9 cases), mucinous cystadenoma (16 cases), and mucinous cystadenocarcinoma (5 cases). Results. After laparotomy and abdominal revision the following operations were performed: 1. Spleen-preserving distal pancreatic resection; 2. Distal pancreatic resection with splenectomy. Pancreatic stump assessment revealed 2 possible complications: external pancreatic fistula and sub. phrenic abscess. Spleen-preserving interventions were shown to associate with fewer complication rate, than those with splenectomy. Conclusions. The cardinal problem is that the PDR associates with repeatedly high complication rate, and the most common complications are external pancreatic fistulas and subphrenic abscesses. As far as the complication rate has the tendency to decrease in spleen-preserving interventions, it is advisable to avoid splenectomy in cases of benign pancreatic lesions. References 1. Fahy B.N., Frey C.F., Ho H.S. et al. Morbidity, mortality and technical factors of distal pancreatectomy. Am. J. Surg. 2002; 183 (3): 237–241. 2. Andren-Sandberg A., Wagner M., Tihanyi T. et al. Technical Aspects of Left-Sided Pancreatic Resection for Cancer. Dig. Surg. 1999; 16 (4): 305–312. 3. Шалимов А.А. Хирургия поджелудочной железы. М.: Медицина. 1964. 4. Mayo W.J. The Surgery of the Pancreas: I. Injuries to the Pancreas in the Course of Operations on the Stomach. II. Injuries to the Pancreas in the Course of Operations on the Spleen. III. Resection of Half the Pancreas for Tumor. Ann. Surg. 1913; 58 (2): 145–150. 5. Алимов А.Н., Исаев А.Ф., Сафронов Э.П. и др. Обоснование безопасности органосохраняющего метода лечения разрыва селезенки в хирургии изолированной и сочетанной травмы живота. Хирургия. 2005; 10: 55–60. 6. Lee S.Y., Goh B.K., Tan Y.M. et al. Spleen-preserving distal pancreatectomy. Singapore Maed. J. 2008; 49 (11): 883–885. 7. Warshaw A.L. Conservation of the spleen with distal pancreatectomy. Arch. Surg. 1988; 123 (5): 550–553. 8 Буриев И.М., Икрамов Р.З. Дистальная резекция поджелудочной железы. Анналы хирургической гепатологии. 1997; 2: 136–138. 9. Kimura W., Fuse A., Hirai I., Suto K. Spleen-preserving distal pancreatectomy for intraductal papillary-mucinoustumor. Hepatogastroenterology. 2004; 51 (55): 86–90. 10. Edwin B., Mala T., Mathisen O. et al. Laparoscopic resection of the pancreas: a feasibility study of the short-term outcome. Surg. Endosc. 2004; 18 (3): 407–411. 11. Vezakis A., Davides M., Larvin M., McMahon M.J. Laparoscopic surgery combined with preservation of the spleen for distal pancreatic tumors. Surg. Endosc. 1999; 13 (1): 26–29.
Abstract: Acute severe pancreatitis is the most severe disease in urgent abdominal surgery In these conditions - diagnosis and treatment of this group of patients remains a high priority issue of urgent surgery and intensive care therapy It is extremely important to estimate severity of local changes and general conditions of patient in order to draw up efficient disease management and forecast the outcome of the disease. It can be done by the use of different scoring systems of severity: J.H.C. Ranson, Glasgow (Imrie), SOFA, APACHE I or II, SAPS, MODS and others. Instrumental methods of investigation are used to examine scale and type of disease of pancreas, retroperitoneum and abdominal: laparoscopy, ultrasonography, computed tomography (CT), magnetic resonance imaging. It is generally recognized that the most informative methods of diagnosis of acute severe pancreatitis and its complications are ultrasound diagnostics and computed tomography In 2008 in Mumbai the Acute Pancreatitis Classification Working Group identified two types of classification - clinical and morphological, the last is based on beam diagnostics. Clinical classification is used during the early stage of disease (within the first week of acute pancreatitis manifestation), morphological classification is applicable to the subsequent stage (usually after the first week of illness). This allows radiologists to describe the «morphology» while clinicians include the results of the examination into the overall clinical picture and draw up the plan of appropriate treatment.
Abstract: Acute severe pancreatitis remains one of the actual issue in urgent surgery Forecast of the disease is dependant on spread of purulent necrotic process in pancreas and retroperitoneal tissues. Therefore diagnosis of purulent complications becomes extremely important. The aim of the study was to demonstrate and evaluate features of ultrasonography in diagnosis and treatment strategy definition of purulent necrotic complications of acute severe pancreatitis. Materials and methods. The study included 115 patients with acute destructive pancreatitis aged of 21-81 years The major part of them (50%) were persons at most able-bodied (working) aged 32-59 years. All patients underwent ultrasound diagnostics for determination the spread of pathology and detection of complications of the disease. Ultrasound scanning was carried out as follows: 1. inspection of pancreatic parenchyma; 2. inspection of cellular tissues; 3. detection of free liquid in the abdominal cavity; 4. evaluation of the abdomen and kidneys; 5. inspection of the pleural cavity Results. Examination of the parenchyma revealed that the pancreas was often inlarged, had a fuzzy, uneven contours and heterogeneous structure. However, it should be noted that in some cases, the pancreas was normal size and structure. Infected necrosis, acute liquid accumulation and/or free liquid in the abdominal cavity had occurred in 100% of cases in various combinations during examination of cellular tissues. Regarding the abdominal organs following complications were revealed: obstructive jaundice - in 5(4.3%) cases; portal vein thrombosis - in 1 (0.9%) case; splenic abscess - in 1 (0.9%) case. The presence of liquid in the pleural cavity was determined by leaves dissociation of the parietal and visceral pleura. The volume of the liquid was determined according standard classification. Conclusion. Ultrasound scanning allows to determine the presence and extent of local complications arising at the stage of purulent necrotic complications of acute severe pancreatitis and general complications as a result of systemic pathological effect on the body of the disease. References 1. Охотников О.И. Перкутанная диапевтика в неотложной абдоминальной хирургии органов панкреато-билиарной зоны. Автореф. ... дис. докт. мед. наук. Воронеж. 1998; 39 с. 2. Echenique A.M., Sleeman D., Yrizarry J. et al. Percutaneous catheter-directed debridement of infected pancreatic necrosis in 20 patients. J. Vase. Interv. Radiol. 1998; 9: 565-571. 3. Затевахин И.И., Цициашвили М.Ш., Будурова М.Д. Комплексное ультразвуковое исследование при остром панкреатите. Анналы хирургии. 1999; 3: 36-42. 4. Scaglione M., Casciani E., Pinto A. et al. Imaging Assessment of Acute Pancreatitis. 5. 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