Modern methods of surgical and conservative treatment of chronic pancreatitis, international protocol, scheme, standard, principles

In the treatment of chronic pancreatitis, several goals are being sought:

  • to eliminate the factor that provokes the disease;
  • to reduce pain syndromes;
  • correction of endocrine insufficiency;
  • correction of exogenous insufficiency;
  • treatment of concomitant disorders.

Depending on the course of chronic pancreatitis and the strength of the pain syndrome, a phased treatment is used, which may include the following:

  • diet food with a fractional diet and amount of fat intake not more than 60 grams per day;
  • reception of the enzyme, penzital, festal, panzinorm, mezim, kroen, pancreatin and other pancreatic enzymes in combination with H2-blockers such as nizatidine, cimetidine, ranitidine and famotidine;
  • reception of voxicam, ibuprofen, diclofenac, acetylsalicylic acid and other non-narcotic analgesics;
  • prescription of sandostatin or octreotide;
  • is carried out endoscopic drainage;
  • appoint sedalgin-neo, tramadol, fortthal, antakson, butorphanol and other narcotic analgesics;
  • is the blockade of the solar plexus;
  • perform a surgical procedure.

Under the methods of surgical treatment of patients on chronic pancreatitis, all types of interference with the use of a scalpel are often implied. Thus, all types of endoscopic procedures and large puncture interventions are considered methods of surgical intervention. Although some doctors do not classify these methods of treatment as surgical, the conditions necessary for carrying out both these and other surgical interventions for chronic pancreatitis give every reason to attribute them to one group of treatment methods.

It is necessary to set the indications for the surgical method of treatment of chronic pancreatitis with caution and on the basis of such indications as:

  1. Pains that are not amenable to treatment by conservative methods, even in the case of prescription of narcotic analgesics;
  2. Development of complications that do not lend themselves to an endoscopic method of treatment, such as clogging of the main bile duct and the appearance of pseudocysts;
  3. Diagnosis of chronic pancreatitis is questioned and suspected of such a disease as pancreatic cancer;
  4. In more rare cases, the methods of surgical intervention for chronic pancreatitis are resorted to with continuous vomiting and with progressive weight loss.

Before the surgical intervention, patients are carefully examined:

  • Endoscopic retrograde pancreatocholangiography is performed if there is a suspicion of scarring of the large duct of the gland and the large duodenal papilla;
  • Ultrasonic dopplerography and Celiacography of the celiac trunk, if there is a suspicion of a sub-hepatic form of portal hypertension, severe peripancreatitis or scar changes in the region of the celiac plexus;
  • If chronic pancreatitis occurs in severe form, it is recommended that a CT scan of the retroperitoneal space and pancreas is recommended;
  • In order to detect pathological changes in the pancreatic ducts, endoscopic ultrasonography or magnetic resonance cholangiopancreatography is performed. In many respects, the methods of using surgical treatment depend on whether the ducts of the pancreas are enlarged. If the ducts of the gland are narrowed, then the doctors raise the question of using a method such as resection of the pancreas or steroid blockade through the skin of the celiac nodes.

    But starting treatment of chronic pancreatitis with the use of surgical methods is impractical. It is worthwhile to resort to such methods of fighting the disease only after having tried all available methods of conservative treatment and making sure that they are useless in this particular case.

    Principles and Protocol for the Treatment of Chronic Pancreatitis

    International Disease Handbook( ICD 10) divides the disease into two main types:

    • chronic form of alcoholic pancreatitis( K86.0),
    • other chronic forms of the disease( K86.1, unspecified etiology).

    The international protocol for the treatment of chronic pancreatitis determines the disease as progressive, accompanied by acute inflammatory process during exacerbations.

    Disease in the clinic is divided into:

    • parenchymatous;
    • is obstructive;
    • calcifying types.

    One-time instrumental research is mandatory. Twice as indicated by biopsy and laparoscopy of the spleen, CT of the pancreas, coagulogram, sugar curve.

    In severe cases with non-occlusive pains, the patient can be placed in a hospital. In principle, treatment in it, without the development of complications, can last up to 30 days.

    Dispensary follow-up at the end of hospital stay should be 1 year. Healing is a person with complete or incomplete remission with the presence of pseudocysts in the spleen.

    Scheme for treatment of chronic pancreatitis

    When the disease worsens in the first 3 days, the food is given parenterally.

    The expressed duadenostasis means continuous aspiration of gastric contents( acidic) by means of thin probes, and also complex medicamentous therapy.

    Non-blocking pain syndrome requires intravenous fluid injections of pain medications.

    After the pains are removed, according to the scheme of the patient, they begin to feed fractional with a sharp restriction of the introduction of animal fats into the diet.

    Standard for the treatment of chronic pancreatitis

    Treatment of the disease, according to the standard, includes two methods:

    • medication;
    • is not pharmacological.

    The second method should be used in parallel with the first and in all cases without exception, exceed it by duration. The non-drug method implies:

    • a complete ban on alcohol consumption;
    • adherence to health food( table number 5);
    • exclusion or reduction in the intake of animal fats.

    According to the standards for the treatment of chronic pancreatitis, when pain is removed, not only analgesics or spasmalytics are prescribed, but antidepressants are also used to activate the antinociceptive system of the brain. Narcotic analgesics, such as tramadol, should be administered with caution, for fear of its effect on the sphincter of Oddi.

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