[Influence of early surgery and endoscopic interventions on the risk of infection in patients with pancreatic necrosis]. / Vliyanie rannikh operativnykh i endoskopicheskikh vmeshatel'stv na risk infitsirovaniya u patsientov s pankreonekrozom.

OBJECTIVE: To prevent purulent-septic complications in patients with destructive pancreatitis. MATERIAL AND METHODS: A cohort study included 488 patients with pancreatic necrosis: group 1 (n=331) - active surgical strategy, group 2 (n=157) - follow-up and therapy. We used binary logistic regression to predict purulent-septic complications. RESULTS: Original model of independent variables significantly (p<0.001) revealed 5.3 times higher risk of infectious complications after laparotomy within the first week after hospitalization. Incidence of these events increased by 2.8 times in patients biliary pancreatitis compared to alcohol-alimentary pancreatitis. Complication rate was higher in older patients (by 2.1% for each year). Risk of purulent-septic complications decreased by 57.4% in women compared to men. There was no significant correlation between risk of infectious complications and endoscopic procedures. Specificity and sensitivity of the model was 74.2 and 72.6%, respectively. CONCLUSION: Original model significantly predicts the risk of purulent-septic complications within the first week after hospitalization. Refusal of early active surgical strategy in these patients will significantly reduce the likelihood of purulent-septic complications.

[Methods of acute pancreatitis prevention after endoscopic transpapillary interventions].

AIM: To optimize preventive methods of acute postoperative pancreatitis in endoscopic transpapillary interventions. MATERIAL AND METHODS: It is performed parallel unblinded randomized investigation. The first group included 98 patients who underwent endoscopic transpapillary interventions and thoracic epidural analgesia (TEA). The second group consisted of 97 patients in whom opiate analgesic intramuscularly and indomethacin per rectum were applied. RESULTS: Study revealed that acute pancreatitis has been diagnosed significantly more seldom in patients after TEA than in the second group (OR 0.22, CI 95%, 0.06-0.83). Thus in TEA-group pancreatitis was verified in 3.1% (3 of 98 patients), in the second group - in 12.4% (12 of 97 patients). Incidence of pancreatitis decreased from 23.3% (10 of 43) to 4.3% (2 of 46) among high risk patients (OR 0.15, 95% CI 0.03-0.75). CONCLUSION: TEA is effective and justified preventive method in patients with high risk of postoperative pancreatitis. In low risk patients use of indomethacin per rectum is preferred compared with TEA due to its invasiveness.