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CHARACTERISTICS AND SPECIFICITY OF TREATMENT AND DIAGNOSTICS OF
BILIARY PANCREATITIS IN ELDERLY Suyunov D.M.1, Madazimov M.M.2, Soliev B.O.3
1Suyunov Dilmurod Muminovich - Assistant; 2Madazimov Madaminjon Muminovich - Professor, DEPARTMENT OF OPTIONAL AND HOSPITAL SURGERY, ANDIJAN STATE MEDICAL INSTITUTE,
ANDIJAN; 3Soliev Begzod Obidzhonovich - Surgeon, 1ST DEPARTMENT OF ABDOMINAL SURGERY, FERGANA BRANCH REPUBLICAN CENTER FOR EMERGENCY MEDICAL AID, FERGANA, REPUBLIC OF UZBEKISTAN
Abstract: during a one-stage clinical study, 48 patients with chronic pancreatitis of different age groups were examined. The article describes the features of the clinical manifestations of this disease in the elderly, and provides comparisons with the clinical symptoms of pancreatitis in middle-aged people.
Differences in the intensity, duration, localization of pain, frequency of symptoms of dyspepsia in patients with biliary pancreatitis of different age groups are shown. A comprehensive assessment of quality of life indicators in elderly patients with chronic pancreatitis revealed a significant deterioration in the quality of life of these individuals according to most scales of general (SF-36) and specific questionnaires compared with indicators in healthy individuals. Keywords: biliary pancreatitis, gerontology, clinical manifestations, health-related quality of life.
ХАРАКТЕРИСТИКА И СПЕЦИФИКА МЕТОДОВ ЛЕЧЕНИЯ И ДИАГНОСТИКИ БИЛИАРНОГО ПАНКРЕАТИТА У ПОЖИЛЫХ ЛЮДЕЙ Суюнов Д.М.1, Мадазимов М.М.2, Солиев Б.О.3
1Суюнов Дилмурод Муминович - ассистент; 2Мадазимов Мадаминжон Муминович - профессор, кафедра факультативной и госпитальной хирургии, Андижанский государственный медицинский институт, г. Андижан; 3Солиев Бегзод Обиджонович - хирург, 1-е отделение абдоминальной хирургии, Ферганский филиал Республиканский центр экстренной медицинской помощи, г. Фергана, Республика Узбекистан
Аннотация: в ходе одномоментного клинического исследования были обследованы 48 больных хроническим панкреатитом разных возрастных групп. В статье описаны особенности клинических проявлений данного заболевания у пожилых лиц, приведены сравнения с клинической симптоматикой панкреатита у лиц среднего возраста.
Показаны различия интенсивности, длительности, локализации болей, частоты симптомов диспепсии у больных билиарным панкреатитом различных возрастных групп. При комплексной оценке показателей качества жизни у больных хроническим панкреатитом пожилого возраста выявлено достоверное ухудшение качества жизни этих лиц по большинству шкал общего (SF-36) и специфического опросников по сравнению с показателями у здоровых лиц.
Ключевые слова: билиарный панкреатит, геронтология, клинические проявления, качество жизни, связанное со здоровьем.
УДК 616.329-089.168.1-071.1
Relevance. In the modern world, there is a steady demographic trend towards the aging of the population. It has been proven that over the past 160 years, life expectancy in economically developed countries has gradually increased at an average rate of 3 months per year [2, 6, 10].
According to United Nations forecasts, by 2025 the number of people over 60 years old will exceed 1 billion, i.e. 15% of the total population of the planet; the proportion of the elderly in the world reaches 16% [4, 9, 11].
The need to create gerontology as a science that studies the laws of the aging process of living beings was first expressed by I.I. Mechnikov in 1903.
In older people, nutrition is unbalanced, alcohol abuse, low physical activity, taking a large number of medications are noted, they often suffer from chronic heart failure, obesity, diabetes mellitus, atherosclerosis, which lead to disruption of the blood supply to all organs, including the digestive system. - all this contributes to the development of the pathology of the corresponding departments [1, 5, 7].
Until now, there are practically no data on epidemiology, clinical symptoms, treatment of elderly and senile patients suffering from chronic pancreatitis (CP) [3,4,8]. In this regard, the relevance of such studies is significantly increasing.
Purpose of the study. Analyze the results of endobiliary interventions, formulate the principles of prevention of complications of endobiliary interventions.
Materials and research methods. The object of this study was to analyze the results of treatment of 48 patients with ductal complications of gallstone disease and a block at the level of the distal part of the common bile duct of benign etiology for the period 2019-2021.
Optimized tactics for acute biliary pancreatitis. The positive clinical and laboratory effect of performing emergency endobiliary interventions has been proven.
It is possible to significantly minimize the level of complications of endobiliary interventions using a number of fairly simple and easily implemented organizational and technological measures: optimal urgency of the intervention, general anesthesia, the use of modern endohemostasis technologies, the use of octreotide and proton pump inhibitors.
Research results. It was found that the most common symptom of acute biliary pancreatitis was pain, which was noted in all patients without exception (100%). The next most frequent symptoms were instrumental and laboratory signs of biliary hypertension (enlargement of the diameter of the common bile duct with ultrasound more than 7 mm - in 88.9 ± 3.0%, an increase in bilirubin more than 32 ^mol - in 84.3 ± 3.5% of cases) ... Clinical and laboratory signs of pancreatic hypertension (vomiting in 81.5 ± 3.7% of patients, and increased blood amylase levels in 78.7 ± 3.9% of cases).
Thus, the identification of these symptoms and their combination is the most frequent and typical for acute blockade of the greater duodenal papilla and as a consequence of acute biliary pancreatitis.
Emergency non-cannulation papillosphincterotomy made it possible to reliably reduce the main clinical manifestations of acute pancreatitis in 8 out of 9 patients. Such indicators as the frequency of pain syndrome (t = 16, p <0.001), indomitable vomiting (t-16.7, p <0.001), dryness of the tongue (t = 6.9, p <0.001) decreased by an order of magnitude. Significant positive dynamics of a number of laboratory parameters was noted: leukocytosis decreased by more than 10 thousand (t = 2.6, p <0.05), amylasemia by more than 100 a.u. (t = 3, l, p <0.01), bilirubinemia more than 32 ^mol / l (1 = 4.6, p <0.001).
Ultrasound data also revealed a positive trend - decreased pancreatic edema (t = 3, p <0.01) and enlargement of the bile ducts (t = ll, 8, p <0.001). After ENPST, we had no fatal complications.
Despite the fact that all patients with an embedded OBD stone are potentially at risk of developing destructive pancreatitis, out of 143 cases of observation, only one patient developed a destructive process in the pancreas (0.69%). The pain syndrome, as a rule, was stopped on the operating table. Postoperative bleeding was noted in 3.7%. Retroroduodenal perforation occurred in one patient (0.69%).
Octreotide was used in 37% of patients, mainly with an initially elevated amylase level.
In the group of patients without acute blockade of OBD, the combination of clinical, instrumental data, with the presence of hyperamilasemia was noted only in 17.5% of cases. The duration of the disease before admission to the hospital was on average 3.6 ± 1.5 days, the average time from admission to the hospital to the performance of retrograde interventions was 1.6 ± 0.2 days. The average level of total bilirubin before the intervention was 76 ± 7 ^mol / L.
ERCP was performed in all cases. In 77%, EPST was performed, of which in 5 cases - non-cannulation. Mechanical extraction of calculus was performed in 56% of cases, of which 22% required mechanical lithotripsy. ERCP combined with choledoch stenting was performed in 36% of cases.
Asymptomatic amylasemia after the procedure was noted in 34% of the total number of interventions. Clinical manifestations of pancreatitis (pain syndrome) without sonographic confirmation of pancreatic edema - in 1.8% of cases, and in 3.7% of cases, amylasemia was accompanied by clinical manifestations and the corresponding ultrasound picture of acute pancreatitis. Postoperative bleeding was noted in 1.8%. Octreotide was used in 67% of patients. When studying the dynamics of the level of amylase, a significantly faster and significant decrease in amylasemia was noted with the use of octreotide than without it.
Output. Emergency (within 1-2 hours) endoscopic non-cannulation papillosphincterotomy and removal of the wedged stone has a pronounced therapeutic effect, which is manifested by reliable positive dynamics of clinical, laboratory and instrumental parameters. Emergency EPST should be used in all emergency surgical settings.
It is possible to significantly minimize the level of complications of endobiliary interventions using a number of fairly simple and easily implemented organizational and technological measures: optimal urgency of the intervention, general anesthesia, the use of modern endohemostasis technologies, the use of octreotide and proton pump inhibitors.
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