Медицинская литература. Новинки

 

 

 

 

 

 

Современные технологии лечения инфицированного панкреонекроза: дифференцированный подход

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Работа основана на анализе данных литературы, посвященной проблеме выбора оперативного пособия при остром панкреатите, за последние 30 лет. Главная цель обзора - выявить ключевые этапы эволюции хирургического подхода к лечению больных инфицированным панкреонекрозом, а также определить наиболее перспективные хирургические методы лечения среди существующих. Проведен анализ наиболее современных клинических рекомендаций, принятых в разных странах мира, а также поиск таких проблем, решение которых будет являться главной задачей мировой медицинской науки в ближайшее время. Установлено, что медицинскими сообществами разных стран отдается предпочтение минимально инвазивным методам санации: чрескожному и транслюминальному эндоскопическому дренированию. Согласно наиболее продвинутым рекомендациям, метод выбора при хирургическом лечении инфицированного панкреонекроза - транслюминальное эндоскопическое дренирование, при неэффективности - чрескожное пункционное дренирование. Главная идея, определяющая вектор поиска методов лечения заболевания, - признание того факта, что все хирургические доступы направлены на достижение одной цели - удаление максимально возможного объема некротических масс с минимальным повреждением окружающих тканей. Только тот метод, который удовлетворяет обоим требованиям, может быть признан ведущим.

Ключевые слова:
поджелудочная железа, панкреатит, панкреонекроз, минимально инвазивные методы, дренирование, pancreas, pancreatitis, pancreatic necrosis, minimally invasive methods, drainage

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Advanced technologies for treatment of infected pancreatic necrosis: differentiated approach

This work is based on analysis of publications devoted to the problem of surgical approach to treatment of acute pancreatitis over the last 30 years. The main aim of this review is to identify the key steps of evolution of surgical approach to treatment of infected pancreatic necrosis and also to determine the most promising approach among existing methods. The analysis of the most modern clinical recommendations adopted in different countries of the world, as well as the search for such problems, the solution of which will be the main task of world medical science in the near future, is carried out. It has been established that medical communities of different countries give preference to minimally invasive methods of debridement: percutaneous and transluminal endoscopic drainage. According to the most advanced recommendations, the method of choice for surgical treatment of infected pancreatic necrosis is transluminal endoscopic drainage, with inefficiency - percutaneous puncture drainage. The main idea that defines the search vector for treatment methods for the disease is the recognition of the fact that all surgical approaches are aimed at achieving one goal - removing the maximum possible volume of necrotic masses with minimal damage to surrounding tissues. Only a method that satisfies both requirements can be recognized as leading.

Keywords:
поджелудочная железа, панкреатит, панкреонекроз, минимально инвазивные методы, дренирование, pancreas, pancreatitis, pancreatic necrosis, minimally invasive methods, drainage