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Year 2017 Vol. 25 No 3
GENERAL & SPECIAL SURGERY
S.A. ALEKSEEV 1, A.K. USOVICH 2, P.P. KOSHEVSKI 1, A.A. DUDKO 1, S.A. SHESTOPALOV 3, A.V. TARASENKO 4, V.S. ALEKSEEV 2
THANATOGENETIC ASPECTS OF MORPHOLOGICAL DISORDERS OF INTERNAL ORGANS AT ACUTE PANCREATITIS
EE "Belarusian State Medical University" 1 Minsk,
EE "Vitebsk State Medical University" 2, Vitebsk
ME "City Clinical Pathoanatomical Bureau"3 , Minsk,
Medical service of the 120th separate mechanized brigade of the Armed Forces of the Republic of Belarus 4,Minsk
The Republic of Belarus
Objectives. To study thanatogenetic aspects of morphological disorders causing the development of lethal outcomes in acute destructive pancreatitis in phases of fusion, sequestration and pyo-septic complications.
Methods. A retrospective analysis of 89 reports of persons died of acute destructive pancreatitis being treated in the healthcare establishments of Minsk (2005-2015) was performed. The examination of 214 histological preparations of the internal organs, stained with hematoxylin-eosin, was carried out.
Results. Subtotal and total affection of the pancreas was established in more than 88% of autopsies, the postoperative peritonitis – in 43,8%, different kinds of purulent parapancreatitis – in 55,1%, generalized phlegmon of the retroperitoneal cellular tissue – in 85,7% of cases. Leading thanatogenetic disorders in persons died of acute destructive pancreatitis were caused by the hepatoprime syndrome, respiratory distress-syndrome, renal and cardiac failure, established in 52,8%, 49,4%, 35,9% and 32,6% of cases, which was confirmed by the relevant morphological changes. The basis of morphological disorders of the internal organs of persons, died from acute destructive pancreatitis are the following: in the liver – edema of the intermediate spaces of hepatocytes (76,6%); lymphoid neutrophilic infiltration of the portal tracts (65,9%) and centrilobular hepatocyte necrosis (75,7%); in the lungs – interstitial edema (75,0%), microvascular thrombosis, desquamation of respiratory epithelium (88,6%); in the kidney – renal tubular epithelial dystrophy (90,6%) accompaying by the development of epithelium necrosis of the convoluted tubules (necrotic nephrosis) (56,3%). At 42 persons, died of the acute destructive pancreatitis, against pyo-septic complications, the signs of septic spleen with atrophy of follicles and «pulp emptying» were revealed, that testify the presence of severe secondary immunodeficiency involving the cellular and humoral components.
Conclusion. The established disorders determine the necessity of improving the diagnostic criteria of acute destructive pancreatitis, carrying out the differentiated surgical approach for performance of programmable necrosequestrectomy in generalized forms and puncture-aspiration interventions in the located restricted cystic-fluid collections, elimination of the main pathogenetic disorders - intoxication, hypoxia and secondary immunodeficiency.
- Hamada T, Yasunaga H, Nakai Y, Isayama H, Matsui H, Fushimi K, et al. No weekend effect on outcomes of severe acute pancreatitis in Japan: data from the diagnosis procedure combination database. J Gastroenterol. 2016 Nov;51(11):1063-72.
- Fedoruk AM. Ul'trasonografiia v diagnostike i lechenii ostrogo pankreatita [Ultrasonography in the diagnosis and treatment of acute pancreatitis]. Minsk, RB: Belarus'; 2005. 125 p.
- Shapkin IuG, Berezina SIu, Tokarev VP. Ranniaia diagnostika i khirurgicheskaia taktika pri ostrom destruktivnom pankreatite [Early diagnosis and surgical tactics in acute destructive pancreatitis]. Khirurgiia Zhurn im NI Pirogova. 2007;(2):34-37
- Dombernowsky T, østermark Kristensen M, Rysgaard S, Lotte Gluud L, Novovic S. Risk factors for and impact of respiratory failure on mortality in the early phase of acute pancreatitis. Pancreatology. 2016 Sep-Oct;16(5):756-60.
- Párniczky A, Kui B, Szentesi A, Balázs A, Szucs &AACUTE;, Mosztbacher D, et al. Prospective, Multicentre, Nationwide Clinical Data from 600 Cases of Acute Pancreatitis. PLoS One. 2016 Oct 31;11(10):e0165309. doi: 10.1371/journal.pone.0165309. eCollection 2016.
- Werge M, Novovic S, Schmidt PN, Gluud LL. Infection increases mortality in necrotizing pancreatitis: A systematic review and meta-analysis. Pancreatology. 2016 Sep-Oct;16(Is 5):698-707. doi: 10.1016/j.pan.2016.07.004.
- Wang M, Lei R. Organ Dysfunction in the Course of Severe Acute Pancreatitis. Pancreas. 2016 Jan;45(1):e5-7. doi: 10.1097/MPA.0000000000000450.
- Tarasenko AV. Analiz rezul'tatov diagnostiki i lecheniia destruktivnogo pankreatita [Analysis of diagnostic results and treatment of destructive pancreatitis]. Med Zhurn. 2014;(1):42-45.
- Zhou J, Li Y, Tang Y, Liu F, Yu S, Zhang L, et al. Effect of acute kidney injury on mortality and hospital stay in patient with severe acute pancreatitis. Nephrology (Carlton). 2015 Jul;20(7):485-91. doi: 10.1111/nep.12439.
- Bagnenko SF, Rukhliada NV, Gol'tsova VR. Diagnostika tiazhesti ostrogo pankreatita v fermentativnoi faze zabolevaniia [Diagnosis of severity of acute pancreatitis in the enzymatic phase of the disease]. Klin-Lab Konsilium. 2005;(7):18-19.
220116, Republic of Belarus, Minsk,
Dzerzhinsky Ave., 83
Belarusian State Medical University,
Department of general surgery,
Tel.: 8 017 226-17-02,
Sergey A. Alekseev
Alekseev S.A. MD, Professor, Head of department of general surgery, EE "Belarusian State Medical University".
Usovich A.K. MD, Professor, Head of department of human anatomy, EE "Vitebsk State Medical University".
Koshevski P.P. PhD, Ass. Professor of department of general surgery, EE "Belarusian State Medical University".
DudkoA.A. Post-graduate student of department of general surgery, EE "Belarusian State Medical University", Head of department of surgery, ME "The 3rd City Clinical Hospital named after E.V.Klumov".
Tarasenko A.V. PhD, Lieutenant Colonel of Medical Service, the deputy chief medical officer of the 120th separate mechanized brigade of the Armed Forces of the Republic of Belarus.
Shestopalov S.A. Head of autopsy department, ME "City Clinical Pathoanatomical Bureau", Minsk.
Alekseev V.S. Medical student of EE "Vitebsk State Medical University".