DIAGNOSTIC LAPAROSCOPY OF ACUTE PANCREATITIS

M.M.MAMAKEYEV, E.A.TILEKOV, R.K.JORTUCHIYEV, B.M.IMANOV

National Surgical Center, Bishkek, KYRGYZSTAN

Introduction. Late diagnosis of individual forms of acute pancreatitis (AP) and untimely treatment are major causes of high mortality in this disease. Introduction of endoscopic methods of research into surgery has increased interest in the use of laparoscopy in the diagnosis and treatment of AP.

Materials and methods of study. The work summarizes the experience of laparoscopic studies in various forms of AP, carried out in NSC of MH of the KR, in 125 patients (66 women and 59 men) aged between 18-65 years, of which 36 patients (30%) were sent to the hospital with the wrong diagnoses. Laparoscopic examination was carried out by us in patients with suspected pancreatic necrosis, as well as in patients with an unclear clinical picture of the disease. Contraindication is an extremely poor condition of the patient.

Results. During the laparoscopy, edematous form (EF) of AP was found in 42 patients, fatty pancreatonecrosis (FPN) in 27, hemorrhagic pancreatic necrosis (HPN) in 48 patients, and diagnostic pitfalls were made in 8 patients. Laparoscopic diagnosis of OP based on the identification of significant (direct) and the likely (indirect) signs. Edematous form of AP is characterized by only likely signs: the ousting of the stomach to the anterior abdominal wall, bulging gastrocolic ligament (75.5%). In case of FPN in the laparoscopic picture prevail patches of steatonecrosis (80.5%). In case of HPN steatonecrosis patches are encountered less common in 69.2% of observations, often of hemorrhagic staining, containing pancreatic enzymes, however, with more expressed manifestations of abdominal inflammation. Intraperitoneal spread of exudation was diagnosed in 38 patients, retroperitoneal - in 6, combined - in 7 patients. In the parallel study, the greatest increase in activity of key enzyme systems of PG was observed in HPN: the level of trypsin and elastase reached 11,6 ± 3,55 med. (Norm - 0-5 med.) and 6,4 ± 1,9 mcg/ ml/min (norm - 0) with the decrease of their inhibitors respectively 209,16 ± 55,4 med. (norm 300-600 med.) and 2,13 ± 0,82 mcg/ml/ min (norm 3-5), transaminase up to 1,93 ± 0,83 med/ml (norm - 0). Such changes of enzyme activity in FPN were not observed by us. 20 of 125 patients were operated at different times after laparoscopy: in 14 – the diagnosis coincided completely, in 3 patients with purulent-necrotic pancreatitis complicated with peritonitis, the causes of peritonitis were not identified laparoscopy. 1 patient with EFAP was operated after 1 month for cholelithiasis, residual manifestations of FPN were revealed during the operation.

Conclusion. Laparoscopic diagnosis of forms of AP with intraperitoneal and combined spread of exudation has a high degree of reliability. If case of only indirect signs of AP it is necessary to correlate the findings with clinical picture of the disease.

Date: 2014-12-28; view: 988