[Classification, clinico-pathophysiological characteristics and treatment principles in pancreatogenic complications of the respiratory tract].
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Biomedical subjects
Publications and source records attributed to V I Filin.
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On the basis of great clinical material (804 patients with pancreatonecrosis) the authors give clinico-morphological characteristics of main components of local pathological changes connected with acute pancreatitis. Debatable questions of the curative methods are described. More exact indications for early surgical interventions are considered in detail.
The authors describe their experience in the surgical treatment of 139 patients with critical forms of necrotic pancreatitis. Operations were fulfilled in 137 of 139 patients. Two non-operated patients died. The article describes in detail the operative technique depending on the character, volume and type of development of the necrotic process. The lowest lethality followed operations in the phase of melting and sequestration due to timely necrosequestrectomy.
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The grounds for expediency of pancreatic resection in various periods of the necrotic pancreatitis clinical course are presented together with the description of a simplier technique of a left-side resection of the gland combined with spleenectomy. The left-side resection of the pancreas was carried out in 74 cases, pancreatoduodenal resection--in 1 patient. 4 patients died.
On the grounds of a great clinical material (4,800 cases) and autopsy findings (857 autopsies) it is emphasized that there is a pathogenetic relationship between thrombotic complications and hemorrhages common in acute pancreatitis and the main disease; the thrombohemorrhagic complications playing a tremendous part in the development of its most severe forms and fatal outcome. The authors divide these complications inherent in all the phases of pancreatitis into 2 groups: early and late ones, which differ from one another by peculiarities of pathogenesis, clinical picture and treatment. The diversity of the complications is stressed, and recommendations on their diagnosis, prevention and treatment are set forth.
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Clinically (in 186 patients) and experimentally the authors studied the peculiarities of variation in microcirculation, organ blood flow and systemic circulation in acute pancreatitis. The authors emphasize the leading role of early arising circulatory disorders in the pathogenesis of acute pancreatitis. The main pathways for correction of hemodynamic disturbances with due account of their causes, character and the sequence of development are described.
In 40 patients with acute pancreatitis, examined 3-2 and 18-24 hours following the onset of the disease, benzoylarginine-amidase activity in blood serum and plasma was determined, as well as the activity of lipase and amylase in blood serum. A correlative dependence was found between the activity of amylase and lipase in blood serum, the activity of amylase in blood serum and trypsin-like activity in blood plasma of patients investigated in different time.
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Pathoanatomical, pathogenetic and clinical characteristics of acute pancreatitis in a sequestration phase are given. Under observation were 95 patients with purulentputrid sequestration of the pancreas and retroperitoneal cellular tissue and 20 patients with postnecrotic pancreatic cysts. Some features of the operative treatment in different kinds of sequestration are described.
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