grekovВестник хирургии имени И.И. ГрековаGrekov's Bulletin of Surgery0042-4625Federal State Budgetary Educational Institution of Higher Education «Academician I.P. Pavlov First St. Petersburg State Medical University» of the Ministry of Healthcare of the Russion Federation, FSBEI HE I.P.Pavlov SPbSMU MOH Russia10.24884/0042-4625-2025-184-6-108-114grekov-2549Research ArticleОБЗОРЫREVIEWSМинимально инвазивная стратегия при инфицированном панкреонекрозеMinimally invasive strategy of infected pancreatic necrosishttps://orcid.org/0000-0002-4743-4565ЧерданцевД. В.CherdancevD. V.

Черданцев Дмитрий Владимирович, доктор медицинских наук, профессор, зав. кафедрой госпитальной хирургии им. проф. А. М. Дыхно с курсом ПО 

660022, г. Красноярск, ул. Партизана Железняка, д. 1

Cherdancev Dmitrij V., Dr. of Sci. (Med.), Professor, Head of the Department of Hospital Surgery named after Prof. A.M. Dykhno with a course of PE 

1, Partisan Zheleznyak str., Krasnoyarsk, 660022

gs7@mail.ruhttps://orcid.org/0000-0002-1221-030XНосковИ. Г.NoskovI. G.

Носков Игорь Геннадьевич, кандидат медицинских наук, доцент кафедры госпитальной хирургии им. проф. А. М. Дыхно с курсом ПО

660022, г. Красноярск, ул. Партизана Железняка, д. 1

Noskov Igor’ G., Cand. of Sci. (Med.), Associate Professor of the Department of Hospital Surgery named after A. M. Dykhno with a course of PE

1, Partisan Zheleznyak str., Krasnoyarsk, 660022

igornoskov@mail.ruhttps://orcid.org/0009-0006-4507-1525ТахтобинЕ. Г.TahtobinE. G.

Тахтобин Евгений Геннадьевич, соискатель кафедры госпитальной хирургии им. проф. А. М. Дыхно с курсом ПО

660022, г. Красноярск, ул. Партизана Железняка, д. 1

Tahtobin Evgenij G., Candidate of the Department of Hospital Surgery named after Professor A.M. Dykhno with a course of PE

1, Partisan Zheleznyak str., Krasnoyarsk, 660022

teg294@mail.ruhttps://orcid.org/0009-0003-6135-3424КомароваА. О.KomarovaA. O.

Комарова Анастасия Олеговна, студентка 6 курса лечебного факультета 

660022, г. Красноярск, ул. Партизана Железняка, д. 1

Komarova Anastasija O., 6th year Student of the Faculty of Medicine

1, Partisan Zheleznyak str., Krasnoyarsk, 660022

nastassikomarova@mail.ruКрасноярский государственный медицинский университет имени профессора В. Ф. Войно-ЯсенецкогоРоссияProfessor V. F. Voino-Yasenetsky Krasnoyarsk State Medical UniversityRussian Federation2025140220261846108114Copyright © Черданцев Д.В., Носков И.Г., Тахтобин Е.Г., Комарова А.О., 20262026Черданцев Д.В., Носков И.Г., Тахтобин Е.Г., Комарова А.О.Cherdancev D.V., Noskov I.G., Tahtobin E.G., Komarova A.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.vestnik-grekova.ru/jour/article/view/2549

Лечение пациентов с панкреонекрозом остается одной из наиболее актуальных и сложных задач неотложной хирургии. Необходимость дальнейших исследований в этом направлении определяется высоким показателем смертности (15–70 %). Активная хирургическая тактика при первой стадии тяжелого панкреатита является вынужденной мерой, направленной на аспирацию перитонеального экссудата и снижение давления в брюшной полости. При второй стадии заболевания развивается инфицированный панкреонекроз с гнойно-септическими осложнениями и полиорганной недостаточностью. На сегодняшний день остается дискутабельным вопрос хирургической тактики при инфицированном панкреонекрозе, особенно в отношении его отграниченных форм. Остается нерешенной проблема выбора оперативного доступа и стратегии. В статье проанализированы различные варианты малоинвазивной хирургии для лечения пациентов с отграниченными формами инфицированного панкреонекроза. Проведен анализ сроков оперативного лечения и методов дренирования и дебридмента (перкутанное дренирование, эндоскопический транслюминальный стент, видео-ассистированная ретроперитонеальная некрсеквестрэктомия или VARD). Также в статье рассмотрена многоэтапная малоинвазивная стратегия с позиции эффективности лечения, частоты развития осложнений и летальности. Большинство исследований рекомендуют придерживаться многоэтапной стратегии, которая позволяет снизить травматичность операции, уменьшить риск осложнений и сократить сроки пребывания пациентов в стационаре. Такой подход является перспективным направлением в лечении пациентов с инфицированным панкреонекрозом.

Treatment of patients with pancreatic necrosis remains one of the most urgent and complex tasks in emergency surgery. The need for further research in this area is dictated by a high mortality rate (15–70 %). Active surgical approach at the first stage of severe pancreatitis is a necessary measure aimed at aspirating peritoneal exudate and reducing pressure in the abdominal cavity. At the second stage of the disease, infected pancreatic necrosis develops with purulentseptic complications and multiple organ failure. To date, the issue of surgical tactics in infected pancreatic necrosis, especially in relation to its walled-off forms, remains debatable. The problem of choosing an operative approach and strategy remains unresolved. In the article, we analyzed various options for minimally invasive surgery for treating patients with walled-off infected pancreatic necrosis. The timing of surgical treatment and methods of drainage and debridement (percutaneous drainage, endoscopic transluminal stent, video-assisted retroperitoneal necrosequestrectomy or VARD) were analyzed. The article also discusses a «step-up» minimally invasive strategy in terms of treatment effectiveness, complication rate and mortality. Most studies recommend adhering to a “step-up” strategy, which allows reducing the invasiveness of surgery, minimizing the risk of complications and shortening hospital stays. This approach is a promising direction in the treatment of patients with infected pancreatic necrosis.

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The authors declare that there are no conflicts of interest present.