UDK: 616.37-002.4
I.N. Klimovich, S.S. Maskin, M.N. Shevcov, V.A. Golbrah, A.G. Arutiunian
Волгоградский государственный медицинский университет, Волгоград, Россия
Intra-abdominal hypertension (IBH) in patients with sterile pancreatic necrosis (SP) leads to the formation of abdominal compartment syndrome (ACS) in 6–8 %. The most vulnerable in this regard are patients with cardiac and pulmonary 95 Т. 19, № 3. 2022 comorbidity (CLC). Difficulties in predicting the development of ACS in most cases do not allow making a timely decision on surgical decompression, which leads to delayed surgical treatment and associated high mortality. Objective: to develop and conduct a clinical evaluation of a method for determining indications for preventive minimally invasive surgical decompression in IBH in patients with SP with cardiac and pulmonary comorbidity. Materials and methods. Prospective cohort studies were performed in 84 patients with sterile pancreatic necrosis with CLC, of which 40 patients were in the main group and 44 in the comparison group. Results and discussion. IBH I–II art. was formed in the main group in 32 (80 %) patients, in the comparison group in 34 (77 %). In 10 (29,4 %) patients from group for comparison, ACS developed, while in all 5 (5/22 – 22,7 %) patients with IBH of the first art., it was not possible to diagnose the syndrome in vivo. Categorically, it became possible to verify ACS only in 5 (5/12 – 41,6 %) patients with type II IBH, however, delayed surgical decompression in 60 % (3 out of 5) cases led to mortality. In the main group of patients with SP with CLC, the developed method for determining indications for preventive surgical decompression in IBH I–II art., allowed to prevent the development of ACS in 34 % (11 out of 32) patients, to reduce the number of intraoperative complications by 43 %, and the minimally invasive variant of operations reduced the number of early postoperative complications by 75 %. Conclusions. The developed method for determining indications for preventive minimally invasive surgical decompression in patients with SP with CLC allowed to reduce the mortality associated with an increase in intra-abdominal pressure by more than 2 times, and the overall mortality by 5,5 %.
intra-abdominal hypertension, abdominal compartment syndrome, cardiac and pulmonary comorbidity, surgical decompression
Игорь Николаевич Климович, klimovichigor1122@yandex.ru