Local cryotherapy on the pancreas with pancreatic necrosis: Results of the experimental study
https://doi.org/10.29413/ABS.2022-7.1.24
Abstract
Background. Acute pancreatitis retains its leading position in the structure of urgent abdominal pathology, maintaining a high postoperative mortality, despite the emergence of new methods of surgical treatment.
The aim of the study: to evaluate pathomorphological changes in the pancreas, surrounding organs and tissues, clinical manifestations in dynamics after local cryotherapy on the pancreas in animals with experimental pancreatic necrosis for subsequent use of the method in clinical practice.
Material and methods. An experimental study was performed on Wistar rats, in the main group, pancreatic necrosis was simulated with subsequent cryotherapy, in the control group, pancreatic necrosis was simulated and simple pancreatic mobilization was performed, in the third group, cryotherapy was performed on an unchanged gland. With the help of modern statistical methods, the effectiveness and safety of cryotherapy techniques were evaluated.
Results. The optimal duration of cryoapplication is an interval of 3–4 seconds at a temperature of –195.75 °C, it is not accompanied by the formation of a cryonecrosis zone, promotes the regeneration of acinuses, does not damage the accumulation of endocrine cells, interrupting the course of pancreonecrosis, does not lead to a fatal outcome, a pronounced adhesive process, other serious intraabdominal complications.
Conclusion. Cryotherapy on the pancreas in experimental pancreatic necrosis in the optimal temperature-time regime is accompanied by significantly lower mortality, is a safe technique and can be tested in clinical practice for the treatment of patients with this pathology.
About the Authors
S. S. Maskin
Volgograd State Medical University
Russian Federation
Russian Federation
Dr. Sc. (Med.), Professor, Head of the Department of Advanced Level Surgery,
Pavshikh Bortsov sq. 1, Volgograd 400131
V. V. Aleksandrov
Volgograd State Medical University
Russian Federation
Russian Federation
Cand. Sc. (Med.), Associate Professor at the Department of Advanced Level Surgery,
Pavshikh Bortsov sq. 1, Volgograd 400131
S. A. Petrenko
Volgograd State Medical University
Russian Federation
Russian Federation
Postgraduate at the Department of Advanced Level Surgery,
Pavshikh Bortsov sq. 1, Volgograd 400131
L. A. Igolkina
Volgograd State Medical University
Russian Federation
Russian Federation
Cand. Sc. (Med.), Teaching Assistant at the Department of Advanced Level Surgery,
Pavshikh Bortsov sq. 1, Volgograd 400131
References
1. Dibirov MD, Domarev LV, Shitikov EA, Isaev AI, Karsotyan GS. Principles of “cliff” pancreatic necrosis in a first-aid hospital. Pirogov Russian Journal of Surgery. 2017; (1): 73-77. (In Russ.) doi: 10.17116/hirurgia2017173-77
2. Rodoman GV, Shalaeva TI. The risk of minimally invasive interventions in severe acute pancreatitis. Khirurg. 2018; 3-4(161): 33-42. (In Russ.).
3. Hines OJ, Pandol SJ. Management of severe acute pancreatitis. BMJ. 2019; 367: l6227. doi: 10.1136/bmj.l6227
4. Leppäniemi A, Tolonen M, Tarasconi A, Segovia-Lohse H, Gamberini E, Kirkpatrick AW, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019; 14: 27. doi: 10.1186/s13017-019-0247-0
5. Avakimyan S, Popandopulo K, Avakimyan V, Didigov M, Marinochkin A. Options for drainage of the purulentnecrotic process in destructive pancreatitis. Danish Scientific Journal. 2020; 33(1): 18-23.
6. Gallyamov EA, Agapov MA, Lutsevich OE, Kakotkin VV. Advanced technologies for treatment of infected pancreatic necrosis: Differentiated approach. Annals of HPB Surgery. 2020; 25(1): 69-78. (In Russ.). doi: 10.16931/1995-5464.2020169-78
7. Klimov AE, Samara M. The role of minimally invasive interventions in the treatment of severe acute pancreatitis. Journal of New Medical Technologies. 2020; (3): 17-19. (In Russ.). doi: 10.24411/2075-4094-2020-16636
8. Revishvili ASh, Kriger AG, Vishnevskiy VA, Smirnov AV, Berelavichus SV, Gorin DS, et al. Current issues in pancreatic surgery. Pirogov Russian Journal of Surgery. 2018; (9): 5-14. (In Russ.). doi: 10.17116/hirurgia20180915
9. Styazhkina SN, Kiryanov NA, Mikhailov AYu, Vasiliev AD, Zhuikova AA, Akimov AA. Pathomorphological changes in acute experimental pancreatitis and methods of their correction and prevention. Experimental & Clinical Gastroenterology. 2020; 180(8): 103-106. (In Russ.). doi: 10.31146/1682-8658-ecg-180-8-103-106
10. Chatila AT, Bilal M, Guturu P. Evaluation and management of acute pancreatitis. World J Clin Cases. 2019; 7(9): 1006-1020. doi: 10.12998/wjcc.v7.i9.1006
11. Pancreatitis: Diagnosis and management. Full guideline. London: National Institute for Health and Care Exellence; 2018.
12. Yokoe M, Takada T, Mayumi T, Yoshida M, Isaji S, Wada K, et al. Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015. J Hepatobiliary Pancreat Sci. 2015; 22(6): 405-432. doi: 10.1002/jhbp.259
13. Kubyshkin VA, Zatevakhin II, Bagnenko SF, Blagovestnov DA, Vishnevsky VA, Galperin EI, et al. Acute pancreatitis. Clinical recommendations. Russian Society of Surgeons. Associations of Hepatopancreatobiliary Surgeons of the CIS countries. Moscow; 2019. (In Russ.).
14. Baranov AYu, Kidalov VN. Cold treatment. Cryomedicine. Saint Petersburg: Anton; 1999. (In Russ.).
15. Chzhao AV, Ionkin DA, Stepanova YuA, Shurakova AB. Cryodestruction of pancreatic malignancy. Vysokotekhnologicheskaya meditsina. 2016; 3(1): 4-17. (In Russ.).
16. Kungurtsev SV, Gazizov NG. Cryosurgical equipment. Vysokotekhnologicheskaya meditsina. 2014; (1): 16-22. (In Russ.).
17. Igolkina LA, Maskin SS, Aleksandrov VV. Application of cryosurgical technology in the treatment of acute pancreatitis. In: Revishvili ASh, Chzhao AV, Ionkin DA (eds). Cryosurgery. Moscow: GEOTAR-Media; 2019: 284-309. (In Russ.).
18. Chen XL, Ma Y, Wan Y, Duan LG. Experimental study of the safety of pancreas cryosurgery: The comparison of 2 different techniques of cryosurgery. Pancreas. 2010; 39(1): 92-96. doi: 10.1097/MPA.0b013e3181bdd41a
19. Ionkin DA, Chzhao AV. Prospects of development of cryosurgery malignant lesions of the liver and pancreas. Vysokotekhnologicheskaya meditsina. 2016; (2): 5-16. (In Russ.).
20. Buyanov VM, Stupin IV, Abdullaev IA. Treatment of experimental pancreatic necrosis by occlusion of pancreatic ducts and cryodestruction of necrotic foci. Grekov’s Bulletin of Surgery. 1989; 142(6): 28-31. (In Russ.).
21. Ionkin DA, Stepanova YuA, Shurakova AB, Chzhao AV. Technical details and results of cryoablation in pancreatic cancer. Klinicheskaya khirurgiya. 2016; 3(27): 24-35. (In Russ.).
22. Maskin SS, Igolkina LA, Aleksandrov VV, Petrenko SA, Klyachin VA. High-tech cryosurgical techniques in the treatment of infected forms of pancreatic necrosis. Vysokotekhnologicheskaya meditsina. 2015; (4): 16-19. (In Russ.).
23. Shugaev AI, Khisamutdinov AA, Gera IN. Cryosurgery of the pancreas in the fight against endogenous intoxication. Efferentnaya terapiya. 1999; (2): 21-23. (In Russ.).
24. Kubyshkin VA, Ionkin DA, Kungurtsev SV, Chzhao AV. History of cryosurgery. Pirogov Russian Journal of Surgery. 2015; (5): 62-74. (In Russ.). doi: 10.17116/hirurgia2015562-74
25. Merzlikin NV, Komkova TB, Tskhay VF, Salo VN, Navasardyan VG, Noroeva TA, et al. The history of the development of cryosurgery in Siberia. Bulletin of Siberian Medicine. 2019; 18(3): 175-182. (In Russ.). doi: 10.20538/1682-0363-2019-3-175-182
26. Igolkina LA, Maskin SS, Aleksandrov VV, Petrenko SA, Pavlov AA. The effectiveness of local cryotherapy in the treatment of pancreatic necrosis. Refrigeration Science and Technology: 3rd IIR Conference on Cold Applications in Life Sciences – Cryotherapy and Cryopreservation, Proceedings. 2018: 39-41.
27. Zatevakhin II, Tsitsiashvili MSh, Girshin GS. Cryodestructions in the surgical treatment of extensive hemorrhagic pancreatic necrosis. Klinicheskaya khirurgiya. 1990; (11): 28-29. (In Russ.).
28. Avtandilov GG. Medical morphometry. Moscow: Meditsina; 1990. (In Russ.).
29. Schneider VE. Experimental substantiation of treatment of pancreatic injury using ultra-low temperatures. Experimental & Clinical Gastroenterology. 2008; (7): 45-49. (In Russ.).
30. Makhnev AV, Musin VM, Molokova OA, Schneider VE, Sozonov AI. Dynamics of pathomorphological changes in pancreatic tissues in the treatment of open pancreatic injury using ultra-low temperatures in the experiment. Medical Science and Education of Ural. 2005; (1): 74-76. (In Russ.).
Review
For citations:
Maskin S.S., Aleksandrov V.V., Petrenko S.A., Igolkina L.A. Local cryotherapy on the pancreas with pancreatic necrosis: Results of the experimental study. Acta Biomedica Scientifica. 2022;7(1):208-219. (In Russ.) https://doi.org/10.29413/ABS.2022-7.1.24
Views:
905
Email this article 
