Novosti
Khirurgii
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Year 2019 Vol. 27 No 5

GENERAL & SPECIAL SURGERY

DOI: https://dx.doi.org/10.18484/2305-0047.2019.5.515   |  

V.P. ANDRIUSHCHENKO, D.V. ANDRIUSHCHENKO, V.V. KUNOVSKYI, Y.S. LYSIUK

EFFICIENCY OF NUTRITIONAL SUPPORT IN SURGICAL TREATMENT OF PATIENTS WITH ACUTE PANCREATITIS

Danylo Halytsky Lviv National Medical University, Lviv,
Ukraine

Objective. To estimate the efficiency of nutritional support in patients with acute pancreatitis using methods of enteral feeding via the probe.
Methods. The investigation included 82 patients with acute pancreatitis: medium-severe - 28; 34% and severe 54; 66%. A general clinical, laboratory-biochemical, ultrasonographic and computed tomography examinations were used. Two groups of patients were identified that were comparable in age, sex, and severity of the disease the main (58), in the treatment complex of which probe enteral nutrition was used and comparative (24), with traditional therapeutic approaches. In the main group, surgical intervention was performed in 43 (74%) and comparative - in 11 (46%) cases. Nutritional support was realized in three ways: by fibrogastroduodenoscopic placement of the probe in the initial section of the small intestine (25), suboperative nasogastrointestinal intubation of the small intestine (12), and the formation of a suspended jejunostoma according to Witzel (21). We used official nutritional mixtures in combination with the probiotic Saccharomyces boulardii (I-745) and the metabolism corrector Malat Citrulline. The following data were evaluated: intestinal motility, indicators of laboratory and biochemical studies (3, 7 days), the dynamics of microstructural changes in the mucous membrane of the small intestine (after finishing the enteral nutrition), suboperative characteristics of the purulent-necrotic focus.
Results. Positive effect was manifested in accelerated restoration of peristalsis, normalization of leukocytosis indexes and blood plasma proteins, positive dynamics of microstructural changes of the small intestine mucous membrane decreasing of necrotized fibers from 16 (94%) to 5 (29%) (χ²=12.454; =0.004), amount of basal/apical membranes detachment from 15 (88%) to 6 (35%) (χ²=7.971; =0.004) and erosive changes from 13 (76%) to 5 (29%) (χ²=5.785; =0.01). Faster cleaning of purulent necrotic focus on the programmed relaparotomy was also registered.
Conclusions. Nutritional support by enteral feeding via the probe is an effective component in surgical treatment of patients with acute pancreatitis. Usage of suspended jejunostomy was the most optimal method and it totally corresponds to the principles of Fast-track surgery.

Keywords: acute pancreatitis, nutritional support, feeding via the probe, jejunostoma, medication compounds, probiotics, metabolism corrector
p. 515-521 of the original issue
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Address for correspondence:
79010, Ukraine,
Lviv, Pekarskaya Str., 69,
Danylo Halytsky Lviv National Medical University,
Department of General Surgery.
Tel. office +38-032-291-72-31,
e-mail: avp.victor@gmail.com,
Victor P. Andriushchenko
Information about the authors:
Andriushchenko Victor P., MD, Professor, Head of the General Surgery Department, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-1848-7358
Andriushchenko Dmytro V., MD, Associate Professor of the Surgery Department of the Post-Graduate Training Faculty, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-1046-7889
Kunovskyi Volodymyr V., PhD, Associate Professor of the General Surgery Department, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0003-2796-4814
Lysiuk Yuriy S., PhD, Associate Professor of the General Surgery Department, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
https://orcid.org/0000-0002-9470-6738
Contacts | ©Vitebsk State Medical University, 2007