Η διέκπλυση του παγκρεατικού πόρου ως πρόληψη στην εξέλιξη της παγκρεατίτιδας: Πειραματική μελέτη

Abstract

The aim of the present experimental study is to be investigated whether the rinse of the pancreatic duct in acute pancreatitis could inhibit the progress of pancreatitis. New Zealand rabbits have been chosen for the specific experiment and 48 of them were used in total, divided in 8 experimental groups (0, 1, 2, 3, 4, 5, 6 and 7). All guinea pigs were subjected to catheterization of the pancreatic duct and acute necrotic hemorrhagic pancreatitis was provoked by effusion of 2ml chenodeoxicholic acid into the duct. In groups 1, 2 and 3 the guinea pigs were being sacrificed during the 1st, 2nd and 3rd hour correspondingly after pancreatitis had been provoked. Guinea pigs belonging to 0 group received no treatment and as a result deceased as the disease evolved. In groups 4, 5, 6 and 7 a catheter remained into the pancreatic duct. Three hours later after the pancreatitis had been provoked, the duct was being rinsed by using a different type of solution in each group. In group 4 the rinse was performed by using a Ringer's Lactate solution, in group 5 Ringer’s Lactate+Solu-Medrol®, in group 6 Ringer’s Lactate+Somastin ® Sb and finally in group 7 by using a Eurocollins® solution. Blood samples were taken from all guinea pigs according a specific timetable in order to be measured particular laboratory parameters. By ending the experimental phase in each case (whether the guinea pig was sacrificed or deceased), laparotomy was performed in order to obtain the pancreas and the tissues around it. The vitiations grading on histological gleanings was made through two different systems: Spormann system and PLoukopoulos system (developed by the scientific group that participated in the experimental study). The experimental study was divided in two levels. In the first one (consisted by experimental groups 1, 2 and 3) the experimental provocation of acute necrotic hemorrhagic pancreatitis was confirmed and the evolving of the hematological and histological parameters was observed during the first three hours from the beginning of the disease. In the second one (consisted by groups 0, 4, 5, 6 and 7) a comparison was made between the evolving of the scaled parameters in group 0 which received no treating intervention and the evolving of the same scaled parameters in groups that had been treated by rinsing the pancreatic duct (groups 4, 5, 6 and 7). In the second level of the study was decided that the maximum observation time would be 24 hours time period were put to death by using Thiopentone and KCL intravenously. From the statistic evaluation of the survival time period and values of the hematological and histological parameters, the following conclusions were made: a) The rinse of the pancreatic duct in acute pancreatitis may inhibit the progress of the disease. b) The solutions that were used in experimental planning did not presented equivalent results. Ringer’s Lactate+Solu-Medrol® solution demonstrated the best biological behavior, as guinea pigs survived and sacrificed by ending the experiment. Ringer's Lactate+Somastin® and Eurocollins® solutions were the next to follow, as guinea pigs had survival time period less that 24 hours and deceased because of the progress of the disease. The different biological behavior between the solutions can also been observed through the variations of laboratory and histological parameters. c) PLoukopoulos system (developed by the scientific group that participated in the experimental study) presents equivalent discernible factors on the descriptive evolution of the disease to Spormann grading scale. According to conclusions a and b we strongly believe that the protocol of this experimental process used for the rinsing of pancreatic duct can actually be a model of therapeutic approach on experimental pancreatitis.

Σκοπός της παρούσας πειραµατικής µελέτης, ήταν να διερευνηθεί εάν η διέκπλυση του παγκρεατικού πόρου μπορεί να δράσει ανασταλτικά στην εξέλιξη της παγκρεατίτιδας. Η μελέτη είχε δύο σκέλη. Στο πρώτο σκέλος επιβεβαιώνεται η πειραματική πρόκληση παγκρεατίτιδας. Στο δεύτερο σκέλος συγκρίνεται η εξέλιξη των μετρούμενων παραμέτρων στην ομάδα που δε γινόταν καμία θεραπευτική παρέμβαση με την εξέλιξη που έχουν οι αντίστοιχες παράμετροι στις ομάδες που γίνονταν διέκπλυση. Από την ανάλυση των αποτελεσμάτων προκύπτει ότι: α) Η διέκπλυση του παγκρεατικού πόρου σε φλεγμαίνοντα παγκρεατικό ιστό μπορεί να δράσει ανασταλτικά στην εξέλιξη της παγκρεατίτιδας. Β) Την καλύτερη βιολογική συμπεριφορά έχει το διάλυμα R/L+Solu-Medrol® με την εφαρμογή του οποίου τα πειραματόζωα επέζησαν και θυσιάστηκαν στο τέλος του πειραματισμού. Γ) Το σύστημα PLoukopoulos έχει ισοδύναμη διακριτότητα στην περιγραφική εξέλιξη της νόσου με το σύστημα βαθμολογήσεων Spormann. Με βάση τα α) και β) πιστεύουμε ότι η πειραματική διάταξη που χρησιμοποιήσαμε για την διέκπλυση παγκρεατικού πόρου σε φλεγμαίνοντα παγκρεατικό ιστό μπορεί να αποτελέσει μοντέλο θερμακευτικής παρέμβασης σε πειραματική παγκρεατίτιδα.