[Pancreonecrosis. Current views and perspectives]

Generalization of data gained from the case records of patients with pancreonecrosis treated at 14 hospitals of Moscow allowed the authors to mark out typical errors in the diagnosis and therapeutic tactics which caused, to a considerable measure, mortality in 58.1 cases. From their personal experience in the treatment of such patients the authors believe it possible to improve essentially the diagnosis of acute pancreatitis by wide use of laparoscopy, ultrasonic scanning, and angiography of the pancreas for early verification of pancreonecrosis, appraisal of the condition of the extrahepatic bile ducts, and application of mildly injurious methods of treatment. Setting apart only two forms of acute pancreatitis is substantiated from the clinico-anatomical standpoint. The choice of the therapeutic tactics in pancreonecrosis should be based on the severity of the disease and the dynamics of its development during intensive therapy, rather than on the morphological diagnosis. Using the criteria of evaluation of the severity of pancreonecrosis, the authors reduced considerably the frequency of operative interventions in the early stages of the disease. Among the methods of operative treatment of pancreonecrosis, distant pancreatectomy or programmed repeated necroso-sequestrectomies are preferred.