Remote Results and Quality of Life of Patients After Surgical Treatment of Pancreatic Necrosis and Its Outcomes

The research is dedicated to the analysis of the remote results of surgical treatment of pancreatic necrosis and its outcomes, as well as the evaluation of the quality of life of patients in the remote period after undergone minimally invasive and traditional surgical interventions. The relevance of the work is due to high mortality in severe forms of pancreatic necrosis and persistent loss of working capacity among a significant portion of those who have suffered from the disease. The work compares the effectiveness of various surgical approaches and evaluates the level of patient satisfaction with life using special questionnaires.

In modern surgical pancreatology, the treatment of acute destructive pancreatitis and its various complications is a complex and most relevant problem. Pancreatitis ranks third among acute surgical diseases of the abdominal organs and accounts for approximately 12.5% of all urgent pathology (Briskin B.S. et al., 2000). In 15-20% of cases, acute pancreatitis is of a destructive nature (Savelyev V.C. et al., 2000; Savelyev V.C. et al., 2001; Prudkov M.I. et al., 2001).

Despite the achieved successes in advancing pathogenetically grounded intensive therapy and minimally invasive methods of surgical treatment, overall mortality over 40 years remains unchanged and ranges from 3.9% to 26%. In infected pancreatic necrosis, mortality reaches 85%, and in fulminant course of the disease - 100% (Beger H.G., 2000; Savelyev V.C., Kubyshkin V.A., 2000; Prudkov M.I., Shulutko A.M., 2001).

Special attention deserves the fact that 70% of patients with acute pancreatitis are persons of active working age. Among patients who have suffered from pancreatic necrosis, 73% develop persistent loss of working capacity, which gives the problem socio-economic significance (Nesterko Yu.A. et al., 2004; Mukhin A.S. et al., 2002).

A large group of patients (57% - 85%) with acute pancreatitis requires exclusively conservative treatment (D.L. Pikovsky, 1995). An abortive course of the disease against the background of adequate therapy allows quickly to curb the manifestations of pancreatitis and discharge the patient from the hospital in a short time.

In contrast to them, the group of patients with severe course of pancreatic necrosis often undergoes surgical interventions. The spectrum of the latter is wide: from minimally invasive gentle manipulations to extensive surgical procedures.

What type of surgical treatment to use? There is still no unambiguous answer. Representatives of various surgical schools often hold diametrically opposite views on this matter and report good treatment outcomes for both, and the other.

Traditionally, the study of results of surgical treatment, especially in the remote period, allows a physician to judge the appropriateness and success of the choice of a particular method of surgical intervention, its overall effectiveness, and its influence on each separate patient, being, thus, a kind of final stage in understanding the disease itself (Vetsev P.S., Krylov N.N., Shpachenko F.A., 2000; Shevchenko Yu.S., 2004).

To date, remote results of surgical treatment have been evaluated by such indicators as mortality, length of hospital stay, presence of postoperative complications, as well as the frequency and degree of severity of various disorders registered by laboratory and instrumental research methods after a certain period of time following the patient's discharge from the hospital. At this, it is often not taken into account that for each specific patient, the improvement of well-being and the degree of satisfaction with life in psycho-emotional and social aspects have greater significance than the dynamics of disease symptoms and laboratory indicators (Novik A.A., Ionova T.I., 2004 Hibbs R., Hick F., 1994).

The universally known principle "to treat not the disease, but the patient", formulated by Professor Botkin S.P. in the mid-19th century, found its expression in modern interpretation in the form of the concept of studying the quality of life of the patient only in the late 20th century.

According to many authors (Vetsev P.S., 2000, Shevchenko Yu.A., 2000), the study of quality of life in surgery can allow reliably to determine the advantages of one or another method of treatment, based not only on quantitative, but also on qualitative characteristics of its results.

Thus, often the study of quality of life is the final stage of evaluating the effectiveness of a particular method of surgical treatment (Vetsev P.S., Krylov N.N., Shpachenko F.A., 2000).

In available literature, we have encountered only isolated publications on the study of remote results of surgical treatment of acute pancreatitis. Works dedicated to studying the quality of life of patients who have undergone surgical interventions for destructive pancreatitis are also extremely few.

Taking into account all the above facts, we consider it relevant to study the remote results after surgical treatment and evaluate the quality of life of patients who have suffered from pancreatic necrosis, which served as the occasion for conducting this research.

RESEARCH OBJECTIVE

The objective of this research is to obtain new data on the remote results of treatment and quality of life of patients who have undergone minimally invasive and traditional surgical interventions for pancreatic necrosis and its outcomes.

RESEARCH TASKS

To achieve the aforementioned objective, it is necessary to solve the following tasks:

1. To study the remote results of surgical treatment of pancreatic necrosis.

2. To study the remote results of surgical treatment of outcomes of pancreatic necrosis.

3. To assess the level of quality of life of patients who have undergone surgical intervention for pancreatic necrosis and its outcomes, using two questionnaires: general and special.

4. To compare the level of quality of life of patients after traditional and minimally invasive surgical treatment of pancreatic necrosis.

5. To substantiate the appropriateness and effectiveness of various types of surgical interventions performed for pancreatic necrosis and its outcomes based on the obtained data on remote results and quality of life of patients.

SCIENTIFIC NOVELTY

1. The representations on the possibilities of using modern methods of surgical treatment of pancreatic necrosis and its outcomes using combined minimally invasive technologies have been expanded.

2. New data on the level of quality of life of convalescents in the remote period after operative treatment of severe forms of pancreatic necrosis and surgical correction of its outcomes have been obtained.

3. The causes contributing to the reduction of quality of life of patients in the remote period after surgical treatment of pancreatic necrosis and its outcomes have been revealed.

PRACTICAL SIGNIFICANCE OF THE WORK

1. The remote results of surgical treatment of pancreatic necrosis after traditional and minimally invasive surgical interventions have been studied and analyzed.

2. A comparative analysis of the quality of life of patients with pancreatic necrosis and its outcomes, operated on traditionally and using minimally invasive interventions, has been conducted.

3. A special questionnaire for studying the quality of life of patients after surgical treatment of pancreatic necrosis and its outcomes has been developed and introduced into clinical practice.

IMPLEMENTATION OF THE RESEARCH RESULTS INTO PRACTICAL ACTIVITY

The results of the dissertation work have been introduced into the therapeutic practice of surgical departments of the clinic of faculty surgery of Volgograd State Medical University based on the clinic of VolGMU No. 1, MUZ KB No. 4, MUZ KB No. 7.

The materials of the dissertation work are used in teaching and conducting practical classes with students, resident physicians, clinical residents, and listeners of the faculty of postgraduate education of Volgograd State Medical University.

DEFENSE OF THE WORK

The main provisions of the dissertation were presented at the X Regional Conference of Young Researchers of the Volgograd Region (Volgograd, 2005); the 54th Scientific Conference of the Professor-Teaching Staff of Volgograd State Medical University, dedicated to the 70th anniversary of the university (Volgograd, 2005); the All-Russian Conference dedicated to the 85th anniversary of the Astrakhan Regional Scientific Medical Society of Surgeons (Astrakhan, 2006).

PUBLICATIONS

6 scientific works have been published on the topic of the dissertation, two of them in the central press.

VOLUME AND STRUCTURE OF THE DISSERTATION

The dissertation is presented on 182 pages. It consists of an introduction, four chapters, conclusions, practical recommendations, a list of literature, and an appendix. It contains 61 tables, 25 figures. The list of literature includes 208 bibliographic sources, including 162 works by domestic authors and 46 foreign ones.