Оptimization of diagnosis and treatment of acute biliary pancreatitis

Objective: improving the effectiveness of immediate results of treatment of acute biliary pancreatitis using the developed diagnostic and treatment algorithm. Material and methods: the work is based on the analysis of the results of diagnostics and treatment of 137 patients with acute BP. The age of the patients ranged from 20 to 82 years. and amounted to, on average 62.17±2.83 years. Among the patients, there were 101 women (73.7%), 36 men (26.3%). The average period from the onset of the disease to admission to the clinic was 5.11±1.89 days and ranged from several hours to 24 days. In the diagnosis of acute BP, a comprehensive approach was used, including analysis of complaints, anamnesis data, objective examination, laboratory and instrumental research methods. Results: the study of cytokine status in patients with PD in the presence of purulent cholangitis against the background of conservative therapy revealed an increase in the concentration of TNF-a, IL-6 and IL-8 in the blood plasma in the first 3-4 days, and IL-4-7 on the day after surgery with a further decrease. The combination of minimally invasive interventions with conservative therapy effectively reduced the content of   TNF-a, IL-4 and IL-6 in the bile of patients with forms of PD, which, compared with the preoperative period,   the concentration of TNF-a, IL-4 and IL-6 in bile was significantly lower by 72.0, 47.6 and 80.3%, respectively. In the postoperative period after combined minimally invasive interventions against the background of the therapy, on the first 3 days, an improvement in the condition was noted in all 65 patients. The average bed-day was 8.3±1.1 days, compared with patients of the second group, which was 26.8±2.2 days. Postoperative complications were noted in 4 (6.1%) patients, versus 14 (19.4%) in the group of patients after traditional operations. 2 (2.8%) patients died after traditional surgery from progressive manifestations of multiple organ failure. Conclusion: modern laboratory and instrumental research methods can most accurately verify and predict complications of biliary pancreatitis. And combined minimally invasive interventions can improve the immediate results of treatment of biliary pancreatitis.

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