FOR THE MEDICAL PRACTITIONER
General Surgery
doi: 10.25005/2074-0581-2025-27-1-219-229
APPLICATION OF EXTRACORPOREAL DETOXIFICATION METHODS IN THE COMPLEX TREATMENT OF PATIENTS WITH INFECTED PANCREATIC NECROSIS

D.T. NAZAROV¹,², M.YU. PERSOV¹, A.E. KLIMOV¹, E.YU. SADOVNIKOVA¹, S.N. ARABZODA³

1Peoples' Friendship University of Russia named after Patrice Lumumba, Moscow, Russian Federation
2Branch of Kazan (Volga Region) Federal University in Jizzakh, Jizzakh, Republic of Uzbekistan
3Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: To investigate the effect of extracorporeal detoxification methods (ECDM) on the effectiveness of treatment in patients with infected pancreatic necrosis (IPN).

Methods: To assess the effectiveness of the applied treatment methods, we applied prospective and retrospective analyses of clinical outcomes in 88 patients diagnosed with IPN. Among all participants, 67 patients (76%) were males and 21 (24%) were females. The age of patients ranged from 18 to 82 years, with a mean of 48.6±1.2 years. To evaluate the impact of ECDM on the effectiveness of IPN treatment, we divided patients into two groups. The main group (Group 1), consisting of 53 patients (60%), received standard conservative and surgical treatment supplemented by extracorporeal detoxification procedures. The control group (Group 2), comprising of 35 patients (40%), were treated without application of ECDM. Statistical data analysis was performed using IBM SPSS Statistics 17.0 (USA).

Results: The use of extracorporeal detoxification procedures in the therapeutic complex for patients with IPN contributed to the improvement of leukocyte count, band neutrophils, and leukocyte intoxication index (LII), and also led to a more pronounced reduction in blood biochemistry indicators (urea, creatinine, glomerular filtration rate (GFR), α-amylase), which, together with a decrease in the mean APACHE II score, indicated a significant improvement in the general condition of patients.

Conclusion: The group of patients receiving ECDM in the comprehensive treatment had a more favourable course of pathology, as demonstrated by the shortened resolution time of local and systemic manifestations of the disease.

Keywords: Infected pancreatic necrosis, multiorgan failure, pancreas, glomerular filtration rate, extracorporeal detoxification, leukocyte intoxication index.

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References
  1. Rizaev KS, Shukurov BI, Sattarov BS. Sovremennye podkhody k khirurgicheskomu lecheniyu destruktivnogo pankreatita [Modern approaches to surgical treatment of destructive pancreatitis]. Vestnik ekstrennoy meditsiny. 2022;15(5):69-75. https://doi.org/10.54185/TBEM/vol15_iss5/a12
  2. Gorskiy VA, Khoreva MV, Agapov MA, Armashov VP. Obosnovanie neobkhodimosti vklyucheniya v kompleksnuyu terapiyu pankreonekroza preparatov, obladayushchikh tsitokiningibiruyushchey aktivnost'yu [Rationale for the need to include drugs with cytokininhibiting activity in the complex therapy of pancreatic necrosis]. Prakticheskaya meditsina. 2017;6:60-5.
  3. Wolbrink DRJ, Kolwijck E, Ten Oever J, Horvath KD, Bouwense SAW, Schouten JA. Management of infected pancreatic necrosis in the intensive care unit: A narrative review. Clin Microbiol Infect. 2020;26(1):18-25. https://doi. org/10.1016/j.cmi.2019.06.017
  4. Boyarinov GA, Zubeev PS, Mokrov KV, Voennov OV. Gemofil'tratsiya u patsientov s tyazhyolym ostrym pankreatitom (obzor) [Hemofiltration in patients with severe acute pancreatitis (review)]. Sovremennye tekhnologii v meditsine. 2020;12(2):105-25. https://doi.org/10.17691/stm2020.12.1.14
  5. Marukhov AV, Khoroshilov SE, Zakharov MV, Nikulin AV, Chubchenko NV. Primenenie ekstrakorporal'noy detoksikatsii v kompleksnom lechenii tyazhyologo ostrogo pankreatita [Extracorporeal detoxification in complex treatment of severe acute pancreatitis]. Anesteziologiya i reanimatologiya. 2020;5:23-9. https://doi.org/10.17116/anaesthesiology202005123
  6. Mikhaylusov SV, Moiseenkova EV. Klinicheskie faktory riska razvitiya infitsirovannogo pankreonekroza [Clinical risk factors for the development of infected pancreonecrosis]. Vestnik DGMA. 2019;2:21-6.
  7. Pavlidis ET, Pavlidis TE. Management of infected acute necrotizing pancreatitis. World J Clin Cases. 2023;11(2):482-6. https://doi.org/10.12998/wjcc.v11.i2.482
  8. Lahiri RP, Karanjia ND. Acute necrotising pancreatitis – early management in the district general hospital and tertiary hepatopancreatico-biliary unit. J Intensive Care Soc. 2019;20(3):263-7. https://doi.org/10.1177/1751143718783605
  9. Nikitina EV, Ilyukevich GV. Zamestitel'nye pochechnye tekhnologii v intensivnoy terapii patsientov s ostrym nekrotiziruyushchim pankreatitom [Renal replacement technologies in intensive care of patients with acute necrotizing pancreatitis]. Khirurgiya. Vostochnaya Evropa. 2021;10(4):460-9. https://doi. org/10.18484/2305-0047.2021.5.401
  10. Baron TH, DiMaio CJ, Wang AY, Morgan KA. American Gastroenterological Association clinical practice update: Management of pancreatic necrosis. Gastroenterology. 2020;158(1):67-75. https://doi.org/10.1053/j.gastro.2019.07.064
  11. Shiryaev NP, Khorev AN, Blagov DA. Znachimost' prodlyonnoy vnutriarterial'noy lekarstvennoy terapii v kompleksnom lechenii pankreonekroza [The significance of prolonged intra-arterial drug therapy in the complex treatment of pancreatic necrosis]. Sovremennye problemy nauki i obrazovaniya. 2019;2.
  12. Oshurkova EF, Rudova ES, Suslov NS. Pankreonekroz i ego khirurgicheskoe lechenie [Pancreatic necrosis and its surgical treatment]. Mezhdunarodnyy studencheskiy nauchnyy vestnik. 2019;3. https://eduherald.ru/ru/article/ view?id=19628
  13. Rashid MU, Hussain I, Jehanzeb S, Ullah W, Ali S, Jain AG, et al. Pancreatic necrosis: Complications and changing trend of treatment. World J Gastrointest Surg. 2019;11(4):198-217. https://doi.org/10.4240/wjgs.v11.i4.198
  14. Ning C, Ouyang H, Shen D, Sun Z, Liu B, Hong X, et al. Prediction of survival in patients with infected pancreatic necrosis: A prospective cohort study. Int J Surg. 2024;110(2):777-87. https://doi.org/10.1097/JS9.0000000000000844
  15. Purschke B, Bolm L, Meyer MN, Sato H. Interventional strategies in infected necrotizing pancreatitis: Indications, timing, and outcomes. World J Gastroenter- ol. 2022;28(27):3383-97. https://doi.org/10.3748/wjg.v28.i27.3383
  16. Mamoon Rashid MU, Hussain I, Jehanzeb S, Ullah W, Ali S, Jain AG, et al. Pancreatic necrosis: Complications and changing trend of treatment. World J Gastrointest Surg. 2019;27;11(4):198-217. https://doi.org/ 10.4240/wjgs.v11. i4.198
  17. Mujahidin, Teuku Y, Dzaky AN. Continuous renal replacement therapy: A review. Journal of Anesthesiology and Clinical Research. 2021;1(2):63-77. https://doi. org/10.37275/jacr.v1i2.138
  18. Sakai M. Efficacy of continuous haemodiafiltration using a polymethylmethacrylate membrane haemofilter in the treatment of sepsis and acute respiratory distress syndrome. Crit Care. 2012;16(Suppl1):P378. https://doi.org/10.1186/cc10985
  19. Mehta RL. Indications for dialysis in the ICU: Renal replacement vs. renal support. Blood Purif. 2001;19(2):227-32. https://doi.org/10.1159/000046946
  20. Gelfand BR, Zabolotskikh IB (red). Intensivnaya terapiya. Natsional'noe rukovod- stvo [Intensive therapy]. Mscow, RF: GEOTAR-Media; 2017. 928 p.
  21. Khoroshilov SE, Nikulin AV. Detoksikatsiya pri kriticheskikh sostoyaniyakh: ponimanie nauchnoy problemy v ХХI veke (obzor) [Detoxification in critical illness: Understanding the scientific problem in the 21st century (review)]. Ob- shchaya reanimatologiya. 2017;13(5):85-108. https://doi.org/10.15360/1813- 9779-2017-5-85-108
  22. Liu C, Li M, Cao S, Wang J, Huang X, Zhong W. Effects of HV-CRRT on PCT, TNF-α, IL-4, IL-6, IL-8 and IL-10 in patients with pancreatitis complicated by acute renal failure. Exp Ther Med. 2017;14(4):3093-7. https://doi.org/10.3892/ etm.2017.4843

Authors' information:

Nazarov Daler Tashtemirovich,
Postgraduate Student, Department of Faculty Surgery, Peoples' Friendship University of Russia named after Patrice Lumumba; Assistant of the Department of Surgery, Branch of Kazan (Volga Region) Federal University in Jizzakh
ORCID ID: 0000-0002-5447-3562
E-mail: danko-88@mail.ru

Persov Mikhail Yurievich,
Candidate of Medical Sciences, Associate Professor, Associate Professor of the Department of Faculty Surgery, Peoples' Friendship University of Russia named after Patrice Lumumba
ORCID ID: 0000-0003-2063-8063
E-mail: persov@yandex.ru

Klimov Aleksey Evgenievich,
Doctor of Medical Sciences, Full Professor, Head of the Department of Faculty Surgery, Peoples' Friendship University of Russia named after Patrice Lumumba
ORCID ID: 000-0002-1397-9540
E-mail: klimov.pfu@mail.ru

Sadovnikova Elena Yurievna,
Postgraduate Student, Department of Faculty Surgery, Peoples' Friendship University of Russia named after Patrice Lumumba
ORCID ID: 0000-0002-3647-7594
E-mail: kostroma18@yandex.ru

Arabzoda Sarvinoz Nozirovna,
Candidate of Medical Sciences, Senior Lecturer of the Department of Normal Physiology, Avicenna Tajik State Medical University
E-mail: arabzoda76@gmail.com

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Nazarov Daler Tashtemirovich
Postgraduate Student, Department of Faculty Surgery, Peoples' Friendship University of Russia named after Patrice Lumumba; Assistant of the Department of Surgery, Branch of Kazan (Volga Region) Federal University in Jizzakh

117198, Russian Federation, Moscow, Miklukho-Maklay str., 6

Tel.: +7 (926) 6515759

E-mail: danko-88@mail.ru


This work is licensed under a Creative Commons Attribution 4.0 International License.

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