METHOD FOR ASSESSING ACUTE PANCREATITIS SEVERITY WITH DETERMINATION OF SURGICAL APPROACH

摘要

FIELD: medicine.;SUBSTANCE: invention reates to medicine, namely to surgery, and it can be used for assessing acute pancreatitis severity and optimizing the therapeutic approach of a patient. Intra-abdominal pressure (IAP) is measured. Haemodynamic characteristics are detected by colour ultrasound-linear Doppler sonography - blood flow velocity in the unpaired tributaries of the portal vein: splenic and superior mesenteric veins and unpaired branches of aorta: celiac axis, common hepatic, splenic, superior mesenteric arteries. When IAP is 10-15 mm Hg. - I degree of intra-abdominal hypertension, reduced speed indicators of venous blood circulation and increased speed characteristics of the arterial blood flow in average by 9 %, intervention is performed during the first days of admission to hospital. Volume of surgery: operative exploration, sanitation and drain of the abdominal cavity. When IAP is 15-25 mm Hg. - II degree of intra-abdominal hypertension, reduced speed indicators of venous blood circulation in average by 27 % and increased speed characteristics of the arterial blood flow in average by 25 % intervention is performed not later than 12 hours from the moment of admission to hospital. Volume of surgery: operative exploration, sanitation and drain of the abdominal cavity, saclesser omental sac and leaks on flanks. When IAP is 25-35 mm Hg. - III degree of intra-abdominal hypertension, reduced speed indicators of venous blood circulation in average by 44 % and increased speed characteristics of the arterial blood flow in the in average by 36 % intervention is performed in 3-6 hours after the preoperative preparation. Volume of surgery: operative exploration, sanitation, drain of saclesser omental sac and abdominal cavity, leaks on flanks, subhepatic space and pelvic organs. When IAP is more than 35 mm Hg. - IV degree of intra-abdominal hypertension, reduced speed indicators of venous blood circulation in average by 54 % and increased speed characteristics of the arterial blood flow in average by 45%, intervention is performed after short-term preoperative preparation. Volume of surgery: operative exploration, sanitation, drain of abdominal cavity and saclesser omental sac, in the presence of signs of bile hypertension - laparoscopic cholecystostomy.;EFFECT: method provides higher reliability of evaluation of patients' severity, increase of effectiveness of surgical management and decrease of postoperative complications due to objectification of the derived values.;1 cl, 1 ex