Necrotizing pancreatitis: the analyze of mortality factors

Abstract

BACKGROUND: Severe acute pancreatitis remains one of the most difficult diseases in diagnostic and treatment. The timely prognosis of course of acute pancreatitis allows correctly choosing tactics of treatment, warning development of complications. THE PURPOSE OF RESEARCH: to conduct the analyze of surgical treatment of patients with acute necrotizing pancreatitis and to identify parameters, which reflect the high risk of an unfavorable course of the disease METHODS: There is an analysis of surgical treatment of 125 patients with severe acute pancreatitis. In postoperative period 34 (27,2%) patients died. The analysis of clinical characteristics of patients with acute pancreatitis with the isolation of a group of patients who died in the hospital from complications of pancreatic necrosis was done. RESULTS: The average age of the deceased was (60,5±3,56) years. In comparison with the average age of the survived patients (47,75±1,89) years. The differences are statistically significant at the level of p<0.05. Analysis of mortality by gender showed that among those women who survived were 31 (68,89 %), dead - 14 (31.11 %), among men those who survived - 60 (75 %), dead - 20 (25 %) (p>0.05). Infected necrosis revealed at 80 (64,0%) patients. Sterile necrosis revealed at 45 (36,0%) patients. In the group of died infected necrosis revealed at 30 (88,2%) patients, sterile necrosis revealed at 4 (11,8%) patients Parapancreatic fat injury revealed at 80 (64,0%) patients. At 26 (76,5%) patients from 34 died parapancreatic fat injury revealed. Thus infected panceatic necrosis increase lethality risk in 37,5%, parapancreatic fat injury increase lethality risk in 32,5%. With chronic comorbidity in 63 (50.4%) patients revealed cardiovascular;pathology 49 (38.0%) - gall-stone disease. Liver disease diagnosed in 17 (13.18%) patients; chronic gastric ulcer and 12 duodenal ulcer - in 13 (10.08%) patients. Obesity II-IV degree detected in 6 (4.8%); cachexia - in 4(3.2%) patients. 7 (5.43%) cases comorbidity was alcoholism; 7(5.43%) cases of renal pathology; 7 (5.43%) cases - diabetes. Pathology of the respiratory system detected in 4 (3.2%) patients; 2 (1.55%) patients had malignant neoplasms; 1 (0.8%) patient suffered from syphilis. In the analysis of comorbidity deceased has been revealed that among patients with cachexia, obesity and alcoholism, the mortality rate was 100%. Among patients with chronic liver disease and kidney disease mortality rate was 54,2%, among patients with pathology of the cardiovascular system 47.6% (p<0.05). CONCLUSION: 1. Postoperative mortality from complications of acute necrotizing pancreatitis is 27.2%. However infected pancreonecrosis and parapancreatic fat injury revealed at 64% of patients with acute necrotizing pancreatitis. 2. High risk of developing post-operative complications in patients with severe acute pancreatitis is caused by the nature of the injury of the pancreas and retroperitoneal fat, age, alcoholic etiology of the disease, presents of disorders of body weight, diseases of liver, kidneys, cardiovascular system.