COMPLEX TREATMENT OF ACUTE PANCREATITIS

T.A.SULTANALIYEV, A.T.DJUMABEKOV, A.J.ARTIKBAIEV,

T.S.JORAYEV, M.K.ABJANOV

Almaty State Institute of Postgraduate Education of Doctors,

Almaty, KAZAKHSTAN

Purpose: To improve results of surgical treatment of acute destructive pancreatitises (ADP) by optimization of the choice of treatment tactics.

Material and methods: Results of treatment of 235 ADP patients of different sex and age groups were studied. Two groups of patients were investigated. The main group - 155 patients treatment of which included open drainage operations as well as videolaparoscopy, subcutaneous injection of somatulin 30 mg, infusion of controloc 40 mg/day, antibacterial therapy with cephalosporins of III generation (rocefin, fortum, medocef) in combination with metronidazolom, as well as monotherapy with tienam or maxipim. The control group - 80 patients, which were performed traditional active surgical tactics for the ADP. The both groups of patients did not differ from each other according to sex, age, comorbidities, and causes of the disease (p> 0.05).

Results of the study. In the main group complications were developed complications in 69 (44.8%) patients, among which bleedings from acute erosions and ulcers of the gastrointestinal tract (GIT) were observed in 5 (3.2%) patients, acute cardiovascular failure (ACVF) - in 5 (3.2%), multiple organ failure syndrome (MOFS) - in 4 (2.6%), peritonitis - in 4 (2.6%), septic complications - in 22 (14.2%) patients.

In the control group MOFS were encountered in 5 (6.2%) patients, peritonitis - in 4 (5%), bleeding from acute GIT erosions and ulcers - in 3 (3.7%), ACVF - in 3 (3.7% ), septic complications in19 (23.7%).

The causes of death in patients of the main group included: pancreatogenous shock - in 5 patients, MOFS - in 7, purulent intoxication and exhaustion - in 7. In the control group at the death-ranking officials were pancreatogenous shock - in 7 patients, PIS - 4, pulmonary embolism-term artery - 1, septic intoxication and exhaustion - in 8, arrosive bleedings - in 8, cardio-pulmonary failure - in 4, MOFS - in 5.

Conclusions. In various forms of ADP, surgical tactics with the use of videolaparoscopy, somatuline and controloc, in addition to open draining operations, allowed to reduce the number of septic complications from 23.7% to 14.2%, overall mortality from 47.5% to 18.7%, postoperative mortality from 47.5% to 24.8%

DIAGNOSTICS OF DISORDERS OF HEMOSTATIC SYSTEM BASED ON D-DIMER AND FIBRINOPEPTID-A DYNAMICS DURING ACUTE DESTRUCTIVE PANCREATITIS

H.A. SULTANOV, V.S. RAHIMOV, T.I. OMAROV

Azerbaijan Medical University, Baku, AZERBAIJAN

Pancreatitises are one of the urgent problems of abdominal surgery, however, despite numerous examinations of pathogenesis, diagnostics and treatment, death rate remains high (8-45 %). One of the reasons of such high figures of death rate is the thrombohemorrhagic (TH) syndrome followed by the dysfunction of vital organs. According to recent data, D-dimer is considered to be one of the reliable indicators of formation of fibrin, and FpA- of intravenous formation of thrombin. Therefore, we set a goal, to study the dynamics of coagulation indicators and paracoagulation tests.

Materials of examination and methods of investigation The investigation was carried out on 105 patients treated and examined in 2005-2010 in the Surgical Resuscitation Department of the Divison of Surgical Diseases I of the AMU and Clinical Medical Center. The patients were at the age of 23-75, and were divided into 3 groups. We carried out a study to determine FpA və D-dimer content in the plasma of 10 somatic healthy donors, FpA - in 39 patients at critical condition (including pancrenecrosis), and D-dimerin in 56 patients with destructive pancreatitis and peritonitis.

Results and discussions. Availability of D-dimerin in plasma of healthy donors, means constant generation and further lysis of fibrin. Simultaneous availability of FpA and D-dimerin in plasma, proves permanent intravenous coagulation hypothesis. In this case incoagulable blood is obtained in the results of two opposite processes of hemostasis. We determined increased FpA in 39 patients with critic condition, the figure was 6,1± 1,9 ng/ml. We observed significant decrease of FpA level under the influence of heparinotherapy, that is, to our mind, is the result of inhibition of thrombin formation. At present, it is beyond dispute, that determination of D-dimerin is a significant diagnostic test. In 56 patients complicated with purulent peritonit and destructive pancreatitis, during the investigation of D-dimerin were observed significant increase of D-dimerin with excess creation of fibrin and lysis ( 500 nq/ml, P< 0,05 as compared to norm). To our mind, FpA and D-dimer take part in the creation of thrombin as a result of activation of hemocoagulation, and plasmin reactions that are components influencing fibrinolysis system. At the same time, in the abdominal surgery, especially in case of the increase of FpA and D-dimerin content during acute destructive pancreatitis show DDL syndrome in the blood, and is of great significance in the diagnostics and follow-up of the disease.

POLYMORPHISM OF II CLASS HLA GENES

IN PATIENTS WITH CHRONIC VIRAL HEPATITIS C

Y.B.TITARENKO, E.A.POPOV, B.N.LEVITAN

State Medical Academy, Astrakhan, RUSSIA

It is known that susceptibility to infectious agents, including hepatitis viruses, is under genetic control of the immune system and is encoded by certain genes of the HLAcomplex. Genetic status largely determines the strength and nature of the immune response of an organism to a foreign antigen, thus defining not only the fact of infection, but the features of the course of disease.

Purpose: search ofimmunogenetic markers of susceptibility and resistance of the developmentof chronic viral hepatitis C (CVHC) among II class HLA genes of DR and DQ lociin the Russian population of Astrakhan gene-geographic area.

Materials and methods: In 31 patients with CVHCand in 300 healthy donors there was performed DNA-typing of allelic variants of DRB1, DQA1 and DQB1 genes by means of “HLA-DNA-TECH” (“NGO DNA Technology”, Moscow) with the use of the method or polymerase chain reaction with sequence - specific primers. 14 allelic variants of the DRB1gene, 8 of DQA1Gene, 12 of DQB1genewere determined. Indicators of the relative risk, etiologic and preventive fraction, reliability of obtained results by using the criterion of χ² were calculated.

Results: In the study of allelic polymorphism of DRB1, DQA1 and DQB1genes in patients with CVHC, deviations in the incidence of a number of HLA specificities towards increase and decrease were found. A significant increase in the frequency of allele groups DRB1 * 01, DRB1 * 04, DQA1 * 0101, DQB1 * 050, as well as trilocci HLA haplotypesDRB1*01/DQA1*0101/DQB1*0501, DRB1*10/DQA1*0101/DQB1*0501 and DRB1*04/DQA1*0301/DQB1*0302 was recorded. Significant reduction in frequency of alleles was established for DRB1 * 15, DQA1 * 0102, triloccihaplotypesDRB1*15/DQA1*0102/DQB1*0602 and DRB1*15/DQA1*0103/ DQB1*0601.

Conclusion.Some immunogenetic markers (among II classHLA genes of DRB1, DQA1, DQB1loci) of high and low risk of CVH in Russians in the Astrakhan gene-geographic zone were established.

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Date: 2014-12-28; view: 751