Clinical models of necrotizing pancreatitis - the way for optimal choise of surgery

Aim. To improve the results of treatment patients with necrotizing pacreatitis. Material and methods. 523 patients with necrotizing pancreatitis (2006-2013) were retrospectively analyzed. We compared results of the CT data, intraoperative locat-dock, the results of histological examination of biopsy material of 77 cases of necrotizing pacreatitis. Revealed their fair match. The main criteria (providing the ability to model) characterizing pancreatic necrosis were volume and localization of pancreatic necrosis, the prevalence of extrapancreatic disease process. Results. Four clinical and morphological models of pancreatic necrosis were created: «Model-1» - 191 patients, «Model-2» - 159, «Model-3» - 95, «Model-4» - 78. Depending on the results of modeling used various methods of treatment of per-cutaneus drainage (PCD), open surgery (OS) and combined step-up approach. Specific complications in cases managed with PCD (n=117) - 8 (6.8%), OS (n=58) - 16 (27.5%); Combined step-up approach - 200 (17.5%) of all (n=375) - 59 (15.7%). The greatest number of complications observed in cases with «Model 3» and «Model-4». Mortality: «Model-1» - 3 (6.9%), «Model-2» - 23 (14.4%), «Model-3» - 21 (22.1%), «Model-4» - 22 (28.2%) of (n=523) - 69 (18.4%). Conclusion. Clinical management of patients with necrotizing pancreatitis is defined by the location and extent of pathological changes in retroperitoneum, depending on the amount, location of pancreatic necrosis. Modeling of pancreatic and peripancreatic necrosis allows in selection of the optimal method of surgery and reduce the incidence of complications, morbidity and mortality.