UDC 616.37-002-036.11-06-07:616.37-031.63.-008.8-091.8-07

 Abstract. Purpose. To study the character and peculiarities of cytomorphological changes of cellular
sediment material of fluid collections (FC) as criterion for objective assessment of the clinical course
severity in acute complicated pancreatitis (ACP).
Materials and methods. The results of cytological researches of peripancreatic sediments of FC
obtained during interventional ultrasonography in 51 (88%) and videolaparoscopy in 7 (12%) observations in 58 patients on ACP were analysed.
Results. It was found that in intraabdominal FC (n=37) in 10 (27%) cases the dominating of proliferative mesothelium with its polymorphism was observed. In 15 cases (41%) degenerative-dystrophic
changes of cytoplasm whippings with the appearance of large “ring-similar” cells were manifested. In
12 studies (32%), atypically altered mesothelium cells with anisocytosis and anisonucleosis, as well as
cytomorphological changes similar to the neoplastic process were detected. In retroperitoneal localization
of FC (n=21) more significant changes were observed in granulocyte-nuclei cells, in particular, in 9 cases
(43%), irreversible violations of their structure were identified as phenomena of cariopicnosis, carioresix
and cariolysis. Was established that depth of structural changes of mesotheliocyte cells and neutrophil
granulocytes depended on degree of ACP severity.
Conclusions. Estimation of cytomorphological changes of the FC cell components can serve as objective criterion of the ACP severity.
Key words: acute complicated pancreatitis, fluid collections, cytological research.

UDC 616.37-002-036.11-06-089-085.456.7

Abstract.

Aim – to evaluate the effectiveness of early enteral nutrition (EEN) in patients with acute complicated pancreatitis (ACP), including clarification of its therapeutic rationale and optimization of administration strategies.Materials and Methods. The outcomes of EEN were analyzed in 82 patients with ACP, including 28(34%) with moderately severe disease and 54(66%) with severe disease. Two patient groups were identified: the main group (n=58), in whom EEN was implemented as a part of comprehensive treatment during preoperative and postoperative periods, and the comparison group (n=24), which received conventional treatment.EEN was performed using various methods: placement of a probe during esophago-gastro-duodenoscopy into the proximal part of the small intestine (n=25), suboperative nasogastrointestinal intubation of the small intestine (n=12), and also the formation of a suspended jejunostoma according to Witzel technique (n=21). nutritional formulas were used in combination with the probiotic Saccharomyces boulardii (I-745) and the metabolic modulator – citrulline malate, including according to the original method.Commercially available enteral Results. The positive effect of the implemented EEN methods was manifested by a more rapid recovery of the motor-evacuatory function of the small intestine, normalization of leukocyte counts and blood protein levels, and attenuation of microstructural changes in the intestinal mucosa. In particular, a reduction in the number of necrotized villi was observed, from 16 (94%) to 5 (29%) (χ² = 12.454; p = 0.004). Decreasing of the frequency of basal/apical enterocyte membrane detachment – from 15 (88%) to 6 (35%) (χ² = 7.971; p = 0.004), and erosive changes – from 13 (76%) to 5 (29%) (χ² = 5.785; p = 0.01) was observed, as well as cleansing of purulent-necrotic focus.Conclusions. EEN represents an effective component of the surgical management of patients with ACP during both the preoperative and postoperative periods.Enteral nutrition via Witzel-type jejunostomy demonstrated the highest efficacy and was fully aligned with contemporary principles of surgical patient management within– «Fast-Track» – surgery.Key words: acute complicated pancreatitis, early enteral nutrition