RU2179854C2 - Method for treating the cases of acute pancreatitis - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves adding Hirudo leeches therapy to traditional therapy complex. EFFECT: enhanced effectiveness of treatment; accelerated treatment course. 3 tbl

Description

 The invention relates to medicine, and more specifically to surgery.

 There are many ways to treat acute pancreatitis, which are divided into two large sections: conservative and surgical.

 Important components of conservative treatment are correction of microcirculation disorders and inactivation of pancreatic enzymes. The basis of a comprehensive conservative treatment of acute pancreatitis are the following basic principles: the elimination of pain; providing functional rest of the pancreas; stabilization of biosynthetic processes in pancreatocytes; detoxification correction of volemic disorders and microcirculation disorders; correction of oxygen metabolism disorders; prevention of purulent complications; replenishment of energy costs. One of the reasons for the development of microcirculatory disorders in acute pancreatitis is the development of thrombohemorrhagic syndrome, which is used to combat heparin in the form of subcutaneous injections in a total dose of 10-25 thousand units / day [5]. At the same time, the dose of heparin should be selected in such a way as to create controlled hypocoagulation with a coiling time of Lee-White 18-23 minutes. Given the possibility of reducing antithrombin-III in these patients, they are shown transfusion of frozen plasma. In addition, with subcutaneous administration of heparin, the creation of therapeutic concentrations in the pancreas is quite problematic, since with an increase in the dose of the drug, the risk of hemorrhagic complications increases sharply. When discontinuing the drug, a consistent reduction in its dose is necessary, otherwise a withdrawal effect may occur, which manifests itself in sharp hypercoagulation. All these shortcomings allow a number of authors to recommend refraining from its use [4, 5].

 Protease inhibitors are used to inactivate pancreatic enzymes [6]. There is still no consensus on the mechanism of action of antienzyme preparations. Some researchers [2] believe that they block plasmokinins of the blood, thereby enhancing the production of their own inhibitors, while others [6] pay most attention to the inhibition of kininogen activity in pancreatic tissue. In addition to the positive reviews on the effectiveness of protease inhibitors in acute pancreatitis, there is evidence of their dubious effectiveness or complete absence of effect. It is reported [8] that the administration of inhibitors does not prevent the development of morphological changes in the pancreas and does not affect mortality and the frequency of complications. The creation of high concentrations of the drug in the pancreas, according to other authors [3], is achieved only with intra-arterial introduction into the celiac trunk, which also presents certain technical difficulties. In addition, their high cost plays an important role.

 The essence of the invention lies in the fact that in the method of treating acute pancreatitis, the pancreas is exposed through the round ligament of the liver by the secretion of the salivary glands secreted by the medical leeches of Hirudo mediacinalis, which are planted on the projection area of the pancreas on the anterior abdominal wall.

 The main component of the secretion of the salivary glands of a medical leech is hirudin - a natural thrombin inhibitor that has a more pronounced effect than heparin. Compared to a number of synthetic thrombin inhibitors, hirudin is an ideal inhibitor of this enzyme. Thrombin inhibition, which manifests itself in slowing down or completely blocking fibrinogen coagulation, is not the only function of hirudin. In his presence, the thrombin activation reaction of coagulation factors V, VIII, XIII slows down. Hirudin interferes with the reaction of platelet release and aggregation, causes dissociation of the thrombin complex with specific receptor proteins on platelets, and removes the formation of thrombokinase by the type of thromboplastin generation.

 In addition, leeches are not only the sources of hirudin. H. Frits [7] in leech homogenates detected, isolated and characterized trypsin, acrosin and plasmin-bdellin inhibitors, as well as eglins, which inhibit alpha-chymotrypsin, subtilisins and neutral proteases of human granulocytes: elastase and cathepsin. I.P. Baskova et al. [1] found a secretion of a human plasma kallikrein inhibitor. The biological importance of these inhibitors depends on their ability to block the activity of leukocyte proteases secreted by inflammatory processes. In the secretion of the salivary glands, enzymes of apyrase, collagenase, triglyceridase, and a number of compounds of an unstudied nature that have an effect similar to prostacyclin were also found. The apyrase enzyme cleaves the residue of phosphoric acid from ATP and therefore has an anti-inflammatory effect, kininases remove the activity of bradykinin. In addition, the secretion of the salivary glands of a medical leech has a diffusion factor due to the enzyme hyaluronidase, which provides free penetration of the components of the secretion of the salivary glands deep into the tissues of the body.

 The method is as follows. The course of treatment usually uses from 12 to 16 leeches, depending on the severity of acute pancreatitis. For one session, 3-4 leeches are used, the interval between sessions is usually 2-3 days.

 3-4 leeches are planted on the area of the projection of the pancreas on the anterior abdominal wall. At the end of the session, the leeches themselves disappear, the bite sites are treated with a solution of alcohol, and an aseptic dressing is applied.

 Results.

 In a comparative analysis of the results of treatment of patients with acute pancreatitis in two groups of patients of 45 people, identical in sex, age, forms and severity of the disease, in the group where hirudotherapy was used, the following features were noted: earlier normalization of leukocytosis and urine amylase level in edematous pancreatitis and pancreatic necrosis by an average of 2-3 days, an earlier start to restore the echo structure of the pancreas and shorten the duration of treatment by an average of 4-5 days.

 The method is illustrated by examples.

 Example 1. Patient T., 63 years old, was treated in 64 GBs from 12/11/96 to 01/30/97 with a diagnosis of pancreatic necrosis, parapancreatic infiltrate, chronic calculous cholecystitis. The diagnosis at admission was confirmed by ultrasound imaging (UST). Hirudotherapy was connected to the ongoing complex of therapeutic measures. Three sessions were held: 12/15/96, 12/18/96, 12/23/96. After the sessions of hirudotherapy, a positive dynamics of the course of the disease was noted. According to UST, a decrease in the size of parapancreatic infiltrate, a decrease in pancreatic infiltration was noted. There were no fluid or infiltrative formations in the pancreas during discharge from the patient according to UST.

 Example 2. Patient S., 67 years old, was treated in 64 GKB from 01.29.98. on 03/05/98, with a diagnosis of pancreatic necrosis, parapancreatic infiltrate, forming a pseudocyst of the pancreas, obstructive jaundice, acute phlegmonous calculous cholecystitis. The patient underwent four sessions of hirudotherapy - 02/01/98, 02/05/98, 02/08/98, 02/11/98. With dynamic ultrasound control, the following features were noted: a decrease in the infiltration and size of the pancreas, a decrease in the size of pseudocysts. At discharge from the patient: the pancreas is slightly reduced, the parenchyma of the gland and parapancreatic fiber without signs of infiltration, pseudocyst size 7 • 4 • 4 cm.

 In both cases, sonograms of patients are available to confirm the results of treatment.

Sources of information
1. Baskova I.P., Khalil S. // Inhibition of human blood plasma kallikrein by the secretion of the salivary glands of the medical leeches of Nirudo medicinalis // Biochemistry, 1988, 53, 9, 1467-1473.

 2. Kizhevatov S.I. Plasmaphoresis in the complex treatment of acute pancreatitis: Abstract. diss .... cand. honey. sciences. - Barnaul, 1989.

 3. Nesterenko Yu.A., Laptev VV // Pancreatic necrosis (diagnosis and treatment). - M., 1987, p. 3-8.

 4. Skuya N.A. Diseases of the pancreas. - M .: 1986.

 5. Tsatsanidi K.N., Pugaev A.V., Fedorko N.A. et al. // Vestn. Khir., 1987, 10, p. 37-40.

 6. Sheverdin Yu.P. // Vestn. Khir., 1989, 1, p. 54-55.

 7. Fritz N. // Trypsin-plasmin inhibitors (bdellins) from leeshes. // Мeth. Enzymol., 1976, 45, 797-806.

 8. Lankish R.G. // Chirurg., 1987, Bd 58, s. 64-69.

Claims (1)

 A method of treating acute pancreatitis by carrying out a complex of therapeutic measures, including the administration of cytostatics, protease inhibitors, anticoagulants and antibiotics, characterized in that 3-4 leeches are additionally planted on the pancreas projection area, using 12-16 leeches with a treatment plan the interval between sessions is 2-3 days.