Method of combined endolymphatic administration of antibiotic and immunomodulator with subsequent ultrasonic cavitation of areas of pancreatogenic destruction

Acute pancreatitis is one of the most pressing problems in emergency surgery. The aim of the study was the development and clinical testing of a new method of combined endolymphatic administration of drugs (antibiotic + immunomodulator of multipoint interaction) with subsequent percutaneous cavitation in patients with acute destructive pancreatitis (ADP). The method was applied in the complex treatment of 21 patients with ADP (group I). The comparison group (group II) included 19 non-operated patients with Acute Pancreatitis (AP), of which 7 had parapancreatitis, 12 had ADP (sterile pancreatonecrosis). As a result of the treatment, patients of group I showed an increase in the level of Immunoreactive insulin IRI by 1.31 times, and in group II there was a further decrease in the level of IRI by 1.14 times, due to a change in the ratio of the absolute number of the main subpopulations of T-lymphocytes and, first of all, T-suppressors , which together may indicate the progression of destructive and inflammatory changes in the tissue of the pancreas or parapancreatic tissue, as well as a decrease in the antibioticinducing effect of treatment. The proposed method in patients with ADP allowed for 14 days of treatment to reduce the rate of severity scales APACHE II and SAPS 3.39 and 1.9 times.

1. Vinnik, Yu. S. Ocenka tyazhesti pankreatogennogo immunodeficita / Yu. S. Vinnik, S. S. Dunaevskaya // Novosti hirurgii – 2003, 21 (№ 4). – S. 40–44.

2. Tarasenko, A. V. Ekspress-diagnostika T-kletochnogo zvena immuniteta i dinamicheskaya immunokorrigiruyushchaya terapiya pri ostrom destruktivnom pankreatite / A. V. Tarasenko, S. A. Alekseev / / Novosti hirurgii – 2010. – № 3. – S. 47–57.

3. Vinnik, Yu. S. Osobennosti immunnogo statusa i prosvetleniya plazmaticheskoj membrany limfocitov pri tyazhelom ostrom pankreatite / Yu. S. Vinnik [i dr.] // Sbornik materialov konferencii, posvyashchennoj yubileyu Moskovskogo gosudarstvennogo medicinskogo universiteta. Semashko «Harizma moej hirurgii» pod redakciej A. B. Laricheva-Yaroslavl’, 2018. – № 1. – S. 85–87.

4. Kubyshkin, V. A. Ostryj pankreatit /V. A. Kubyshkin // Tihookeanskij med. Zhurnal – 2009. – № 2. – S. 48–52.

5. Nesterenko, Yu. A. Diagnostika i lechenie destruktivnogo pankreatita / Yu. A. Nesterenko, V. V. Laptev, S. V. Mihajlusov // M.: Binom - press, 2004 – 304 s.

6. Bal’tazar, E. I. Vizualizaciya podzheludochnoj zhelezy/ Ostryj i hronicheskij pankreatit / E. I. Bal’tazar, A. I. Medibov, Mucelli R. Pocci / / Springer-2009. – S. 64–87.

7. Krasil’nikov, A. V. Mnogokomponentnaya endolimfaticheskaya terapiya v profilaktike i lechenii posleoperacionnogo pankreatita / A. V. Krasil’nikov [i dr.] // trudy nauchno-prakticheskogo seminara. konferenciya Associacii hirurgov // SPb, 2002. – s. 222–224.

8. Savel’ev, V. S. Varianty techeniya pankreonekroza, opredelyayushchie vybor optimal’noj taktiki hirurgicheskogo lecheniya / V. S. Savel’ev [i dr.].

9. Dovganyuk, A. P. Ul’trazvukovaya terapiya / A. P. Dovganyuk // Fizioterapiya, kurortologiya i reabilitaciya. – 2008. – № 3. – S. 45–52.