nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”10.23934/2223-9022-2020-9-2-238-250nmp-937Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESСравнительный анализ результатов различных способов резекции головки поджелудочной железы при хроническом панкреатитеComparative Analysis of the Results of Various Methods for Pancreatic Head Resection in Chronic PancreatitisПроппА. Р.ProppA. R.

Пропп Александр Робертович, ассистент кафедры госпитальной хирургии; заведующий хирургическим отделением

644033, Омск, ул. Березовая. д. 3

644099, Омск, ул. Ленина, д. 12

Assistant of the Department of Advanced Surgery; Head of the Surgical Department

3 Beryozovaya St., Omsk 644033

12 Lenina St., Omsk 644099

par1108@mail.ruhttps://orcid.org/0000-0003-0385-8232ДеговцовЕ. Н.DegovtsovE. N.

Деговцов Евгений Николаевич, доцент, доктор медицинских наук, заведующий кафедрой госпитальной хирургии

644099, Омск, ул. Ленина, д. 12

 

Dr. Med. Sci., Associate Professor, Head of the Department of Advanced Surgery

12 Lenina St., Omsk 644099

edego2001@mail.ruБУЗ Омской области «Областная клиническая больница»; ФГБОУ ВО «Омский государственный медицинский университет»РоссияRegional Clinical Hospital; Omsk State Medical UniversityRussian FederationФГБОУ ВО «Омский государственный медицинский университет»РоссияOmsk State Medical UniversityRussian Federation20202110202092238250Copyright © Пропп А.Р., Деговцов Е.Н., 20202020Пропп А.Р., Деговцов Е.Н.Propp A.R., Degovtsov E.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/937

Актуальность Более чем в половине наблюдений хронического панкреатита (ХП) диагностируется увеличение головки поджелудочной железы (ПЖ) с наличием осложнений, которые служат показанием к резекции органа. Разработка оптимального способа хирургического лечения ХП с поражением головки поджелудочной железы (ГПЖ) является одной из задач хирургической панкреатологии.

Цель Провести сравнительную оценку непосредственных и отдаленных результатов различных способов резекции ГПЖ при ХП.

Материал и методы Выполнено проспективное контролируемое исследование со сравнительным анализом результатов хирургического лечения 131 пациента с ХП с увеличением размеров ГПЖ. В 29% (n=38) наблюдений у больных присутствовали осложнения воспалительного характера, в 86,3% (n=113) они были связаны с компрессией соседних органов, в том числе диагностированы механическая желтуха (n=60), непроходимость на уровне двенадцатиперстной кишки (ДПК) (n=43), и региональная портальная гипертензия (n=10). Проведено 47 панкреатодуоденальных, 58 субтотальных и 26 частичных резекций ГПЖ.

Результаты При дуоденосохраняющих резекциях ГПЖ получены статистически значимо лучшие непосредственные результаты по сравнению с панкреатодуоденальными резекциями. Субтотальная резекция ГПЖ в бернском варианте превосходила все остальные дуоденосохраняющие резекции по показателям средней продолжительности операции, послеоперационного стационарного лечения, интраоперационной кровопотери. Частота релапаротомий по поводу внутрибрюшных осложнений геморрагического характера при этом составила 8,2% (n=4). Частота неблагоприятного эффекта по параметру сохранения боли через 5 лет после дуоденосохраняющих резекций ГПЖ составила 0,125, а после панкреатодуоденальной резекции — 0,357 при статистически значимой величине относительного риска (RR), равной 0,350 (ДИ 95%=0,13–0,98). По остальным показателям клинических отдаленных результатов хирургического лечения в зависимости от различных способов резекции ГПЖ статистически значимых различий получено не было (p>0,05). Качество жизни больных через 5 лет после операции, согласно анкете EORTC QLQ-C30, статистически значимым  (р=0,0228) получено только по двум показателям: одышка (DY:8,3) и бессонница (SL:16,67;27,4) с более высокими значениями после операций Beger и бернского варианта субтотальной резекции ГПЖ соответственно.

Background In more than half of cases of chronic pancreatitis (CP), enlargement of the pancreatic head is diagnosed with the presence of complications that serve as an indication for organ resection. The development of an optimal method for the surgical treatment of CP with damage to the pancreatic head (PH) is one of the tasks of surgical pancreatology.

Aim of study To perform comparative evaluation of immediate and late results of different types of PH resection in CP.

Material and methods A prospective controlled study was conducted with a comparative analysis of the results of surgical treatment of 131 patients with CP with pancreatic head enlargement. In 29% (n=38) cases inflammatory complications were revealed, in 86.3% (n=113), they have been associated with compression of adjacent organs, jaundice also developed (n=60), as well as duodenal obstruction at the level of duodenum (n=43), regional portal hypertension (n=10). A total of 47 pancreatoduodenal, 58 subtotal, and 26 partial resections of the pancreas were performed.

Results Duodenum preserving pancreatic head resections had significantly better short-term results compared to pancreatoduodenal resections. Subtotal PH resection in the Bern’s version was superior to all other resections in terms of average duration of surgery, postoperative inpatient treatment, and intraoperative blood loss. The frequency of relaparotomy for intraperitoneal complications of hemorrhagic etiology was 8.2% (n=4). The frequency of the adverse effect according to pain preservation 5 years after duodenum preserving resection tract was 0.125; after pancreatoduodenal resection - 0.357 with a statistically significant relative risk (RR) of 0.350 (CI95% = 0.13–0.98). According to other indicators of clinical long-term surgical treatment depending on the various methods of PH resection, there were no statistically significant differences (p>0.05). The quality of life of patients 5 years after the operation according to the EORTC QLQ-C30 questionnaire was statistically significant (p=0.0228) by only two indicators: dyspnea (DY:8.3) and insomnia (SL:16.67; 27.4) with higher values after operations of Beger and the Bern’s version of the subtotal PH resection, respectively.

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The authors declare that there are no conflicts of interest present.