THE SIGNIFICANCE OF LAPAROSCOPY IN THE PROGNOSIS AND TREATMENT OF ACUTE PANCREATITIS

Аннотация

INTRODUCTION to identify and assess severity. Thus, the main Acute pancreatitis is a serious health problem both priority in this field is the development of new in Uzbekistan and worldwide because of its methods to assess the degree of pancreatic tissue prevalence and severity. The high mortality rate in damage at early stages. the development of pancreonecrosis, which can range from 20 to 40%, emphasizes the importance The aim of the study is to create new indicators of early diagnosis and improved treatment of acute for predicting the severity of acute pancreatitis pancreatitis. Many cases go undetected in the early based on data obtained during laparoscopy. stages, especially fatal cases, making them difficult https://www.theamericanjournals.com/index.php/tajmspr 28 THE USA JOURNALS THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH (ISSN – 2689-1026) VOLUME 06 ISSUE03 METHODS level of transaminases (ALT, AST). 102 patients with acute destructive pancreatitis In 36 patients (35,3%) gallstones were detected at complicated by fermentative peritonitis were ultrasound examination of abdominal cavity treated in surgical departments of the organs. Total dilation of bile ducts was found in 11 multidisciplinary clinic of Samarkand State Medical cases (10.8%). Increased pancreatic volume and University in 2018-2023. All these patients increased tissue echogenicity were found in a underwent laparoscopy within the first 72 hours of preliminary study involving 32 patients (31.4%). In onset. For comparison, 42 patients with acute 46 cases (45.1%), the pancreas was not described pancreatitis with tumors also participated in the or was seen fragmentarily due to obvious study. The total number of patients was 144, flatulence. including 90 men and 54 women, with ages ranging Esophagogastroduodenoscopy (EGDS) was from 53.6 to 3.4 years. performed in 67 patients (65.7%) within the first An international working group on the subject three days of onset. developed a classification system for acute Computed tomography of the pancreas is usually pancreatitis in 2012. performed within 5-7 days of admission and to Indications for laparoscopy were: the presence of evaluate the pancreatic parenchyma, more than 200 ml of fluid in the abdominal cavity, parapancreatic changes, and to detect fluid in the which is confirmed by ultrasound or CT data; and abdomen and retroperitoneum. the need for differential diagnosis of this disease in Diagnostic laparoscopy was performed using other urgent abdominal pathology. equipment developed by the German company Karl According to clinical examination and history, the Storz and standard technique A laparoscope with a most frequent causes of acute pancreatitis were: diameter of 5 millimeters and a viewing angle of 30 alcohol abuse and dietary disorders in 49 patients; degrees was introduced through paraumbilical intrahepatic and extrahepatic bile duct diseases in access. A drainage tube was inserted to collect fluid 36 patients, including choledocholithiasis and for later analysis after exudate was detected in the cholelithiasis; and other mixed or unclear causes in abdominal cavity. The drain was used for several 17 patients. Each patient was hospitalized during days until the exudate from the abdominal cavity the first three days of illness. was stopped. The most common complaints were: severe Depending on the laparoscopic picture, all patients epigastric pain, often of a cingulate nature, in all with symptoms of destructive pancreatitis were 102 patients (100%); nausea, vomiting, flatulence, divided into two groups. Evaluation of pathologic and stool disturbances and dyspeptic changes in 77 changes revealed the following subgroups: patients (75.4%); and general weakness, 1) in Group M (moderate severity), 71 patients tachycardia, and unstable hemodynamic changes (69.6%) had minor pancreatogenic exudative in 45 patients (44.1%). changes in the abdominal cavity; Subfebrile fever was reported in 24 patients, or 2) Group G included 31 patients (30.4%) with more 23.5% of the total number. severe pathologic changes in the abdomen, which Peripheral blood analysis revealed leukocytosis means" severe Gravis". with a leftward shift of leukoform in 89 patients Figure 1 shows the results of laparoscopy in 102 (87.2%). Biochemical studies showed an increased patients. level of amylase in blood and urine in 91 patients (89.2%). In 28 patients (27.4%) there was an We developed a system for evaluating pathologic increase in the level of bilirubin above 30 mmol/l, signs of acute pancreatitis based on laparoscopy in 33 patients (32.4%) there was an increase in the findings. This system consists of five main https://www.theamericanjournals.com/index.php/tajmspr 29 THE USA JOURNALS THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH (ISSN – 2689-1026) VOLUME 06 ISSUE03 elements: laparoscopic picture. The α-amylase activity in abdominal fluid was ten to fifteen times higher than