Il trattamento multidisciplinare della pancreatite acuta: considerazioni su 244 casi.

Background: Acute pancreatitis (AP) has still a high mor- tality rate; therefore tbe accuracy o/ the predictors o/ seue- rity actually employed and the therapeutic cboices are under debate. The aim o/ this work is to valuate the accuracy o/ the prognostic factors actually employed and the results o/ a multidisciplinary treatment o/ the AP. Methods: A consecutive series 0/2441atients affècted by AP (J 68 mild, 76 severe) is analyse . Mean age 64, 4 years (range 17-94 years old). As regard as aetiology is con- cerned, 166 are biliary pancreatitis, 42 alcoholic, 27 idio- pathic, 9 iatrogenic. Ranson's sco re, Balthazar criteria, and ASA are employed to assess the high-risk patients. Tbe treat- ment is medicai and in severe AP the patient is admitted in ICU. 80 patients affècted biliary AP undergo an ERCP. An endoscopic papillotomy is performed in 55 cases and in 49 biliary stones are removed. 90 patients underwent a delayed colcistectomy. Il patients underwent a surgical treat- ment: 9 (or infected necrotic pancreatitis, 1 jor a bemorrha- gic shock, 1 flr peritonitis. The overall mortality, tbe mortality related to the severity o/ the AP, the prognostic evaluation o/ the ethioloy, tbe ASA index, the Ranson and Balshazar scores are evaluated. Results: The overall mortality rate is 2,8% (0,6% in the mild AP and 7,8% in the severe AP). In tbe surgical group tbe mortality rate is 18,1%. The Ranson's score is the only independent [actor in the multivariate analysis (p<0,0374) while a/so the Balthazar classification is significant in the univariate analysis. Conclusion: As regard as the prognostic [actors in AP are concerned, the Ranson's score and Balthazar criteria are reliable even if many other predictors o/ severity are tested to make progress in the early detection o/ the complications. As regard as the therapy is concerned, the endoscopic papil- lotomy and the endoscopic removal o/ the biliary stones is tbe gold standard in the treatment o/ the biliary AP. In the otber cases o/ AP medicai treatment shall be started as early as possible with intensive care management in the severe AP. In patients with infected pancreatic necrosis or haemorrhage or peritonitis, surgery is tbe only therapeutic choice while the surgical treatment in case o/ sterile pan- creatic necrosis with MODS unresponsive to medica! the- rapy is still under debate.