milmedВоенная медицинаMilitary Medicine2074-5044Белорусский государственный медицинский университет10.51922/2074-5044.2026.2.111milmed-7Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESОстрые жидкостные скопления при остром панкреатитеAcute fluid collection in acute pancreatitisМазаникА. В.MazanikA. V.

Минск

Minsk

ГУ «432 ордена Красной Звезды главный военный клинический медицинский центр Вооруженных Сил Республики Беларусь»Беларусь432 Order of the Red Star Main Military Clinical Medical Center of the Armed Forces of the Republic of BelarusBelarus20260808202602111119Copyright © Мазаник А.В., 20262026Мазаник А.В.Mazanik A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://milmed.ejournal.by/jour/article/view/7

В обзоре представлены классификация, ключевые патогенетические механизмы, особенности клинического течения и современные принципы оперативного лечения острых жидкостных скоплений, осложняющих течение острого панкреатита.

Острые жидкостные скопления образуются при остром панкреатите более чем в 50 % случаев, предопределяя среднетяжелое или тяжелое течение заболевания. Острые жидкостные скопления формируются в результате первично асептического воспалительного отека в зоне деструкции поджелудочной железы (ранняя фаза), асептической секвестрации с последующим расплавлением (разжижением) некротизированной ткани (поздняя фаза) и нарушения целостности протоковой системы поджелудочной железы, что может происходить в разные сроки от начала заболевания.

Инвазивное лечение острых жидкостных скоплений показано при их инфицировании, сохраняющейся или впервые возникшей органной недостаточности, внутрибрюшной гипертензии, развитии симптомов или осложнений. Для инвазивного лечения острых жидкостных скоплений применяют чрескожные (под УЗ– или КТ-контролем), эндоскопические (трансмуральные или транспапиллярные) и оперативные (открытые или малоинвазивные) вмешательства. Возможно их комбинирование и/или последовательное выполнение. Вероятность применения различных методов инвазивного лечения острых жидкостных скоплений в каждом конкретном случае определяют необходимость многопрофильного (с участием хирургов, анестезиологов-реаниматологов, врачей лучевой и эндоскопической диагностики) подхода к оказанию медицинской помощи при данной патологии.

Между тем, до настоящего времени доказательно не определены четкие и однозначные показания к инвазивному лечению острых жидкостных скоплений, не регламентированы критерии выбора оптимальных сроков, метода, доступа и объема вмешательства.

The classification, key pathogenetic mechanisms, clinical course and modern principles of surgical management of acute fluid collections complicating the course of acute pancreatitis are presented in this review.

Acute fluid collections are formed in acute pancreatitis in more than 50 % of cases, predetermining medium or severe course of the disease. Acute fluid collections are formed as a result of primary aseptic inflammatory edema in the zone of pancreatic gland destruction (early phase), aseptic sequestration with subsequent melting (liquefaction) of necrotized tissue (late phase) and violation of integrity of pancreatic duct system, which can occur at different terms from the onset of the disease.

Invasive treatment of acute fluid collections is indicated in case of their infection, persisting or first appeared organ failure, intra-abdominal hypertension, development of symptoms or complications. For invasive treatment of acute fluid collections percutaneous (under US or CT control), endoscopic (transmural or transpapillary) and operative (open or minimally invasive) interventions are used. They may be combined and/or performed sequentially. The probability of application of different methods of invasive management of acute fluid collections in each specific case determine the need for a multidisciplinary (with the participation of surgeons, anesthesiologists-resuscitators, radiation and endoscopic diagnostics doctors) approach to medical care for this pathology.

Meanwhile, up to now, clear and unambiguous indications for invasive management of acute fluid collections have not been evidently defined, the criteria of choosing the optimal terms, method, access and volume of intervention have not been regulated.

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