Usporedba minimalno invazivnog i otvorenog kirurškog pristupa u liječenju akutnog nekrotizirajućeg pankreatitisa s inficiranom nekrozom

professional thesis

• Title (english): Comparison of minimally invasive and open surgical approach in the treatment of acute necrotizing pancreatitis with infected necrosis
• Author: Ivan Romić
• Mentor: Hrvoje Silovski (mentor)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2023-03-22, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Akutni nekrotizirajući pankreatitis s inficiranom nekrozom praćen je visokom stopom komplikacija i smrtnosti. Optimalno liječenje još uvijek je predmet stručnih i znanstvenih rasprava, ali minimalno invazivni pristup u liječenju akutnog pankreatitisa privukao je mnogo pažnje u posljednjem desteljeću. U ovome radu, prikazali smo rezultate liječenja minimalno invazivnim pristupom te ih usporedili s rezultatima standardne otvorene nekrozektomije. Provedeno je retrospektivno istraživanje koje obuhvaća period od 2011. do 2021. godine, a uključeni su svi bolesnici iz Kliničkog bolničkog centra Zagreb. Za komparativnu analizu bolesnici su upareni u omjeru 2:1 na temelju težine pankreatitisa te je u konačnici analizirano 60 bolesnika. Kod 40 je provedena otvorena nekrozektomija, a kod 20 minimalno invazivni pristup. Nije bilo značajne razlike u demografskim karakteristikama bolesnika niti u težini pankreatitisa na temelju Ransonovih kriterija ili CT indeksa težine pankreatitisa. Bolesnici iz MIP skupine imali su značajno manju stopu komplikacija i stopu disfunkcije gušterače. Smrtnost u MIP skupini bila je 20%, a u ON skupini 27.5% što nije bilo statistički značajno. U zaključku, minimalno invazivni pristup nije manje efikasan od ON u kontroli izvora sepse kod bolesnika s ANPom i inficiranom nekrozom. Istovremeno, MIP je povezan s manjom stopom komplikacija i dugoročne disfunkcije gušterače dok se smrtnost i trajanje hospitalizacije nije značajno razlikovalo između skupina.

Abstract (english)

Acute necrotizing pancreatitis (ANP) with infected necrosis is associated with a high mortality and complications rate. The optimal treatment approach remains a topic of clinical and scientific research, but the minimally invasive (MI) approach has attracted much attention over the last decade. In this study, we compared the clinical outcomes of minimally invasive approach (MIA) and an open necrosectomy (OK) in the treatment of acute necrotizing pancreatitis. We conducted a retrospective cohort study at the Clinical Hospital Center Zagreb, in a period from 2011 to 2021. For the comparative analysis, the patients were matched in a ratio of 2:1 based on the severity of pancreatitis, and ultimately 60 patients were analyzed. An open necrosectomy was performed in 40 cases, and a minimally invasive approach in 20 cases. There was no significant difference regarding demographic characteristics or the severity of pancreatitis based on the Ranson criteria or the CT severity index. Patients from the MIP group had a significantly lower complication rate and pancreatic dysfunction rate. Mortality in the MIP group was 20%, and in the ON group 27.5%, which was not statistically significant. In conclusion, the minimally invasive approach is not less effective than ON in controlling the source of sepsis in patients with ANP and infected necrosis. At the same time, MIP is associated with a lower rate of complications and long-term pancreatic dysfunction, while mortality and length of hospitalization did not significantly differ between the groups.

• Keywords: Pankreatitis; akutni nekrotizirajući; Bolnice; Nekroza; Tomografija; Hospitalizacija; Demografija; Sepsa
• Keywords (english): Pancreatitis; Acute Necrotizing; Hospitals; Necrosis; Tomography; Hospitalization; Demography; Sepsis
• Language: croatian
• URN:NBN: urn:nbn:hr:105:523490
• Study programme: Title: Abdominal surgery; Study programme type: university; Study level: postgraduate specialist; Academic / professional title: sveučilišni/a magistar/magistra abdominalne kirurgije (sveučilišni/a magistar/magistra abdominalne kirurgije)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-01-26 09:35:58