Vol. 5, Issue 6 (2016)

Author(s):
VI Pylypchuk

Abstract:
Surgical treatment was applied to 144 patients with chronic pancreatitis (CP). In 54 (37.5%) patients, CP was complicated by dysfunction of adjacent organs. Particularly, these were biliary hypertension (BH) in 36 (25%) patients and chronic duodenal obstruction (CDO) in 8 (5.5%) patients. In 5 (3.5%) patients, BH was combined with CDO, and another 5 (3.5%) patients had a combination of BH, CDO and venous hypertension (VH) of the portomesenteric area. Indications for surgical treatment were as follows: persistent pain syndrome and inefficiency of pharmaceutical treatment; manifest duct hypertension due to fibrotic CP with dilatation of pancreatic ducts and pancreatic juice hypertension in hem or calculous CP with manifest intrapancreatic hypertension – 48 (33.3 %) patients; fibrocystic CP with formation of retention cysts, pseudocysts and external fistula of the pancreas - 27 (18.7 %) patients; fibrous-degenerative CP with involvement of adjacent organs and their dysfunction (BH, CDO, VH, and their combination) - 54 (37.5%) patients; pancreatic pseudotumor and assumption of a pancreas tumor – 10 (6.9%) patients. Resection surgeries were performed in (43.4 %) patient (pancreaticoduodenal resection (PDR) – 5 (3.5 %), Frey’s procedure – 44 (30.5 %), Berne modification - 2 (1.4 %), distal pancreas resection – 10 (7 %). Draining operations were performed in 74 (51.4%) patients, palliative surgeries - in 9 (6.2 %) patients. In 16 patients with CP accompanied by signs of BH, intraoperative monitoring of biliary pressure was performed, which allowed determining the appropriateness of the surgery for the elimination of BH. The results of surgical treatment were traced in 43 (29.8 %) patients in the period from 6 to 36 months and appeared to be good and satisfactory. Life quality indicators were better in patients who underwent resection surgeries on the pancreas.