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Year 2019 Vol. 27 No 5
GENERAL & SPECIAL SURGERY
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,
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; ð=0.004), amount of basal/apical membranes detachment from 15 (88%) to 6 (35%) (χ²=7.971; ð=0.004) and erosive changes from 13 (76%) to 5 (29%) (χ²=5.785; ð=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.
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Lviv, Pekarskaya Str., 69,
Danylo Halytsky Lviv National Medical University,
Department of General Surgery.
Tel. office +38-032-291-72-31,
Victor P. Andriushchenko
Andriushchenko Victor P., MD, Professor, Head of the General Surgery Department, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
Andriushchenko Dmytro V., MD, Associate Professor of the Surgery Department of the Post-Graduate Training Faculty, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
Kunovskyi Volodymyr V., PhD, Associate Professor of the General Surgery Department, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.
Lysiuk Yuriy S., PhD, Associate Professor of the General Surgery Department, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.