RESUMO
INTRODUCTION: High incidence of necrotic and suppurative complications is feature of acute post-traumatic pancreatitis. Severe trauma of the pancreas and post-traumatic pancreatitis lead to depressurization of ductal system that requires adequate drainage of damaged area and retroperitoneal fat. MATERIAL AND METHODS: 95 patients in group 1 received standardized treatment. The victims of the 2nd group (44 patients) were treated using immunoreactive therapy (roncoleukin) and octreotide (the dose depended on the severity of pancreatitis) at early stages. The efficacy of treatment was assessed based on clinical, laboratory and instrumental parameters. RESULTS: Regardless severity of pancreatic injury overall mortality in groups 1 and 2 was 41% and 20.5% respectively. The main causes of adverse outcomes are severe destructive pancreatitis, postnecrotic suppurative complications. CONCLUSION: Adequacy rather radicalism of surgery should be preferred for blunt pancreatic trauma management. Minimally invasive surgical techniques and new methods of biological hemostasis may be applied. Timely use of anti-enzymatic and immunoactive therapy reduces the risk of severe post-traumatic pancreatitis, suppurative complications and improves outcomes in patients with blunt pancreatic trauma.
Assuntos
Traumatismos Abdominais/complicações , Drenagem/métodos , Hemostasia Cirúrgica/métodos , Octreotida/administração & dosagem , Pâncreas , Pancreatite , Adjuvantes Imunológicos/uso terapêutico , Adulto , Feminino , Fármacos Gastrointestinais/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/patologia , Necrose/terapia , Pâncreas/lesões , Pâncreas/patologia , Pancreatite/etiologia , Pancreatite/patologia , Pancreatite/terapia , Índices de Gravidade do Trauma , Resultado do Tratamento , Ferimentos não Penetrantes/complicaçõesRESUMO
AIM: to assess types of immune response in patients with advanced suppurative peritonitis and course of disease. MATERIAL AND METHODS: We examined 79 patients with acute surgical abdominal diseases and injuries complicated by advanced suppurative peritonitis. Blood immunological parameters were estimated using flowing cytometry and enzyme immunoassay. RESULTS: It was concluded that functional parameters of immune system are very various in patients with advanced suppurative peritonitis. Cluster analysis defined 4 immune types which are determined by different state of congenital and acquired immunity. Immunodeficient and unreactive immune types are unfavorable. Immune types with activation of congenital and acquired immunity are the most favourable. This stratification personifies diagnosis and treatment of immune disorders in patients with advanced suppurative peritonitis.
Assuntos
Traumatismos Abdominais/complicações , Imunidade Adaptativa/imunologia , Gastroenteropatias/complicações , Peritonite/imunologia , Gerenciamento Clínico , Feminino , Humanos , Imunocompetência , Masculino , Pessoa de Meia-Idade , Monitorização Imunológica/métodos , Peritonite/etiologia , Peritonite/fisiopatologia , Peritonite/terapia , Reprodutibilidade dos Testes , Estatística como AssuntoRESUMO
Evaluation of the efficacy of sekretoliticeskoj therapy with synthetic analogue of somatostatin, a short-acting oktreotid (group 1) and extended oktreotid-depo (group 2) in 24 patients with external pancreatic fistulas after destructive pancreatitis. Results of clinical studies have shown that against the backdrop of an analogue of somatostatin-depo true healing and purulent-necrotic pancreatic external fistula occurs in less time: average 19 ± 1.8, and 16.2 ± 1.2 day observations, respectively.
Assuntos
Antibacterianos/administração & dosagem , Fístula Cutânea/tratamento farmacológico , Octreotida/administração & dosagem , Pâncreas Exócrino/efeitos dos fármacos , Fístula Pancreática/tratamento farmacológico , Adulto , Amilases/metabolismo , Pesquisa Comparativa da Efetividade , Fístula Cutânea/etiologia , Fístula Cutânea/metabolismo , Formas de Dosagem , Quimioterapia Combinada , Feminino , Fármacos Gastrointestinais/administração & dosagem , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Pâncreas Exócrino/metabolismo , Fístula Pancreática/etiologia , Fístula Pancreática/metabolismo , Pancreatite/complicações , Resultado do Tratamento , Cicatrização/efeitos dos fármacosRESUMO
Results of the treatment of generalized purulent peritonitis in 30 patients are presented. Based on the analysis of the performance of integrated assessment scales severity of the condition, the dynamics of change of bacterial contamination and microbiological landscape, and analysis of morbidity and mortality proved the effectiveness of intraperitoneal administration of the solution of dioxidin in patients with generalized purulent peritonitis.