RESUMO
In 38 elderly and senile patients, in whom an acute necrotic pancreatitis (ANP) was diagnosed, morphological changes in the walls of intra- and extrapancreatic arteries were studied, including dorsal pancreatic artery, big pancreatic artery (Heller) and their branches. The patients were operated, using open surgical access, on the 10 - 26-th day after admittance to hospital for purulent-septic complications of pancreonecrosis. In total 9 (24%) patients died. Changes of intra- and extrapancreatic arteries causes the essential reduction of the splanchnic blood flow intensity and necrotic changes in pancreatic parenchyma and parapancreatic cellular space.
Assuntos
Artéria Mesentérica Superior/patologia , Pâncreas/patologia , Pancreatite Necrosante Aguda/patologia , Artéria Esplênica/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Microscopia , Pâncreas/irrigação sanguínea , Pâncreas/cirurgia , Pancreatite Necrosante Aguda/mortalidade , Pancreatite Necrosante Aguda/cirurgia , Circulação Esplâncnica , Análise de SobrevidaRESUMO
The results of treatment of 89 patients, suffering an acute accumulations of liquid (AAL)and postnecrotic pancreatic pseudocysts (PPP) on background of an acute necroticpancreatitis, were studied. The volume of AAL and PPP have constituted from 65 to2750 cm3. The alcohol abuse and alimentary factor--in 63 (70.7%) patients, biliary calculous disease--in 21 (23.6%), and other--in 5 (5.7%) have constituted the diseasecauses. In 33 (37%) patients miniinvasive interventions were performed, and in the rest--the endoscopic. Miniinvasive and endoscopic interventions for PPP were done in 4-8 weeks from the disease beginning.
Assuntos
Ascite/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Pâncreas/cirurgia , Pseudocisto Pancreático/cirurgia , Pancreatite Necrosante Aguda/cirurgia , Adolescente , Adulto , Idoso , Ascite/patologia , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Pseudocisto Pancreático/patologia , Pancreatite Necrosante Aguda/patologia , Estudos RetrospectivosRESUMO
The results of treatment of 99 elderly and senile patients, suffering an acute pancreatitis in period of 2005 - 2013 yrs, were analyzed. Interstitial acute pancreatitis was diagnoses in 36 (36.3%) patients, focal pancreatic necrosis--in 32 (32.3%), total-subtotal pancreonecrosis--in 31 (31.3%). Miniinvasive interventions were performed in 40 (63.4%) patients, the open--in 24 (38%). The main indication for laparotomy conduction were purulent-septic complications, which is impossible to eliminate while miniinvasive methods application. Due to application of the staged treatment tactics with predominant application of miniinvasive methods, extracorporeal detoxication and improvement of the intensive therapy measures postoperative lethality in necrotic acute pancreatitis have had lowered from 16.7 to 10.3%.