Estimation of state severity degree of patients and of efficacy of various treatment methods at subtotal-total pancreatonecrosis
Objectives. To estimate the possibilities of minimally invasive technologies in treatment of patients with subtotal-total forms of pancreatonecrosis (PN) in early stages of the disease. Methods. The analysis of 668 patients' case histories with acute pancreatonecrosis was carried out; the group including 112 (16, 7%) patients with subtotal-total forms of pancreatonecrosis was established; the results of their treatment were analyzed. The patients were divided into 3 groups the 1<sup>st</sup> group - 39 (34, 8%) patients in whom only intensive conservative therapy was applied; the 2<sup>nd</sup> group - 31 (27, 7%) patients in whom minimally invasive technologies (open and half-open methods of treatment) were additionally used during the process of treatment; the 3<sup>rd</sup> group - 42 (37, 5%) patients who were treated using various operative surgical techniques (open method). Severity of patients' state as well as the course prognosis was evaluated using scales of polyorgan insufficiency MODS, APACHE III before and after used methods of treatment. Results. In early terms in all patients severe systemic disturbances were noticed together with extensive lesions of the pancreas. The estimation system of severity and prognosis APACHE III permitted to reveal the relation between the degree of polyorgan insufficiency and the degree of expressiveness of the accompanying pathology. Application of multicomponent intensive conservative therapy and minimally invasive operative interventions allowed getting a favorable result in 67 (95, 7%) patients, in all three groups - in 95 (84, 8%) patients. The general lethality at subtotal-total pancreatonecrosis in early terms of the disease correlates with the type and volume of treatment; in the group of patients with conservative treatment it made up 5, 1%; with application of minimally invasive technologies - 3, 2%; with the application of laparotomy - 33, 3% correspondently. Conclusions. Subtotal-total forms of pancreatonecrosis occur in 16, 7% patients with the verified acute pancreatitis. APACHE III scale at subtotal-total pancreatonecrosis permits to evaluate the state severity degree and to predict the efficacy of the applied complex therapy. Application of minimally invasive technologies allows decreasing lethality rate at pancreatonecrosis at early terms of the disease.