RESUMO
The authors analysed 373 patients with acute pancreatitis which developed after operations on the organs of the pancreatoduodenal zone. Acute postoperative pancreatitis developed in 17.15% of cases after operations on the biliary tract, in 26.8% after resection of the stomach for ulcer, and in 51.47% of cases after resection of the stomach for carcinoma. A comparative evaluation of various methods for the prevention and treatment of acute postoperative pancreatitis (APP) is given, with appraisal of the traditional therapy (154 patients) without the use of protease inhibitors, and various methods of administration of protease inhibitors (135 patients) and cytostatics (84 patients). The mortality rate in progressive forms of APP was 25.2%, mortality being highest (30.4%) in treatment by the traditional methods including protease inhibitors and lowest in inclusion of cytostatics in the complex of therapeutic measures (7.1%).
Assuntos
Antineoplásicos/uso terapêutico , Pancreatite/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Inibidores de Proteases/uso terapêutico , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite/diagnóstico , Pancreatite/etiologia , Pancreatite/mortalidade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Taxa de SobrevidaRESUMO
The authors analysed 105 patients with traumatic damage of the pancreas in its closed (92) and open (13) injury. Isolated damages were encountered in 25, multiple in 67, and combined in 13 patients. Contusion of the gland was found in 73, injury to the parenchyma in 21, and parenchymal-duct injuries in 11 patients. The features of the clinical manifestations are discussed according to the time, type, and severity of the trauma and the efficacy of various methods of examination in early diagnosis is evaluated. The therapeutic tactics is discussed according to the type and severity of the damage, and the results of nonoperative (7) and various surgical treatment (98) are shown. The complications and the causes of fatal outcomes are analysed. Traumatic pancreatitis was the most frequent complication, its destructive forms were encountered in 24.5% of cases; pancreonecrosis occurred in 2.7% of patients with mild trauma of the gland. The mortality rate of progressive forms of pancreonecrosis was 12.24%.
