International Medical Journal, Vol. 24., Iss. 4, 2018, P. 20−23.
DIAGNOSIS OF INFECTED PANCREATIC NECROSIS
State Enterprise "Institute of General and Emergency Surgery named after V. T. Zaitsev, NAMSU", Kharkiv
Kharkiv National Medical University, Ukraine
Today, the infection of the centers of pancreatic destruction is considered the main factor, which leads to high mortality in acute pancreatitis. The infected pancreatic necrosis is the earliest form of pancreatic infection and is characterized by the proliferation and penetration of microorganisms in necrotized areas of tissues surrounding the pancreas, which are often found in the extraocute area during the most severe course of acute pancreatitis. The emergence of minimally invasive variants of pancreatic necrosis and pancreatic abscesses has expanded the range of effective therapeutic measures. However, now it is necessary to precisely differentiate them depending on the prevalence, limitation and localization of lesions of pancreatic infection, determination of place and role in the treatment of infected pancreatic necrosis. To this end, 46 (67 interventions) in patients with acute necrotizing pancreatitis were performed with percutaneous thin−layer aspiration biopsy of parapancreatic cellular tissue under ultrasound−control with microbiological research of biomaterial for the purpose of verifying purulent−septic complications of pancreatic necrosis. Technique of thin−blood aspiration biopsy consisted of the following stages: 1) choice of puncture site; 2) local anesthesia (usually a solution of novocaine 0.25 % 20−30 ml); 3) visual control of the end of the aspiration needle; 4) visual control of changes in the place of the puncture in the aspiration process; 5) evaluation of the aspirates and sending them to morphological, bacteriological and biochemical studies; 6) ultrasonic monitoring of changes in the area of intervention after aspiration. As a result of the research, it was found that the thin−layer aspiration biopsy of parapancreatic tissue with microscopic examination of punctal tissue has a high sensitivity of 84.2 %, specificity of 96.6 %, positive predictive value of 97.0 %, negative predictive value of 82,4 % and overall accuracy −− 89.6 % in the differential diagnosis of sterile and infected pancreatic necrosis. In addition, it is important to study the cellular composition of the contents of the acute liquid clusters. The use of the developed method of diagnosis of infected pancreatic necrosis enables to timely identify the infectious complications of pancreatic necrosis, which helps to reduce untimely (early) operations and the number of cases of systemic complications.
Key words: pancreatonecrosis, complications, fine−needle aspiration biopsy.