Application Research Of The Interventional Ultrasound Technologies For Early Minimally Invasive Treatment In Pancreatic Acute And Severe Diseases

Part 1:Application Research of the volume navigation assisted interventional ultrasound technology for early minimally invasive treatment in pancreatic contusion and lacerationObjective:Investigate the application and effect of volume navigation assisted with interventional ultrasonic technique for early minimally invasive treatment in pancreatic contusion and laceration. In order to alleviate the condition, prevent the development of the disease, improve the survival and prognosis. Create a new method for early minimally invasive treatment of pancreatic contusion and laceration.Methods:Constructed the mini porcine pancreatic contusion and laceration model and compared volume navigation assisted with contrast-enhanced ultrasound guided. Evaluated traumatic lesions of the puncture positioning time, puncture injection time, puncture and injection of medicine in accuracy, and the occurrence of complications. Early intervention by medical anastomosis glue and protease inhibitors in pancreatic contusion and laceration, to observe and evaluate the curative effect of different intervention methods, in terms of pancreatic function, abdominal effusion formation, pancreatic pathological injury.Results:In porcine pancreatic contusion and laceration model, contrast-enhanced ultrasound could improve the discovery rate for pancreatic contusion and laceration compared to conventional ultrasound (60% vs 35%), but no significant difference (P> 0.05). Volume navigation group compared to contrast enhanced ultrasound group significantly shorten the puncture point position time(P< 0.01) and significantly shorten the puncture and injection time (P< 0.01), improve the puncture accuracy (100% vs.67%), but no significant difference (P> 0.05), the two groups did not occur any serious complication.The group of medical anastomotic glue combined with ulinastatin(UE) get the best effect in the early intervention treatment of pancreatic contusion and laceration. ①Pancreatic function:in the range of 0～24h throughout the observation interval, the levels of amylase and lipase in UE group elevated at the least, the results of the increase of amylase and lipase compared with the control group (C) respectively were:0～6h amylase (P< 0.01). lipase (P> 0.05).6～12h amylase (P> 0.05). lipase (P< 0.01).12～24h amylase (P< 0.01). lipase (P< 0.01); the results compared with the ulinastatin group (UL) respectively were:0～6h amylase (p< 0.05), lipase(p>0.05),6～12h amylase(p>0.05), lipase (p< 0.01),12～24h amylase (p< 0.01), lipase (p< 0.01); the results compared with the medical anastomotic glue (EC) respectively were:0～6h amylase (p< 0.01), lipase (p>0.05),6～12h amylase (p>0.05), lipase (p< 0.01),12-24h amylase (P< 0.01), lipase (P< 0.01). ②In the range of 0-24h throughout the observation interval, the depth of peritoneal effusion in UE group increase the least, the results of the increase of the depth compared with group C respectively were:0-6h (P< 0.01),6-12 h (P< 0.01),12-24h (P< 0.01); the results compared with the group UL respectively were:0-6h (P< 0.05),6 ～12 h (P< 0.01),12～24h (P< 0.01); the results compared with the group EC respectively were:0-6h (P> 0.05),6-12 h (P> 0.05),12-24h (P< 0.01). ③Pancreatic pathological score:the pancreatic pathology score of UE group was the lowest, compared with other groups, the results were:C group (P< 0.01), UL group(P< 0.05), EC group (P< 0.01).Conclusion:The volume navigation assisted interventional ultrasound technique for early minimally invasive interventional therapy in pancreatic contusion and laceration can bring better operation, accuracy and security compared with the conventional contrast-enhanced ultrasound guidance; Using ulinastatin combined with medical anastomotic glue for treatment of early intervention in pancreatic contusion and laceration could effectively control the progression of the disease and improve the prognosis, and has better therapeutic effect and higher clinical application value. In the early course of the development process of pancreatic contusion and laceration, serum lipase than amylase in the assessment of disease development may more sensitive and accurate, and may become the important prediction and evaluation prognosis and treatment index in pancreatic contusion and laceration.Part 2:Effect of interventional ultrasound assisted peripancreatic drug lavage in early minimally invasive treatment of severe acute pancreatitisObjective:Research of therapeutic effects and mechanism using early peritoneal lavage with protease inhibitors in severe acute pancreatitis. Through interventional ultrasound technology assisted peripancreatic drug lavage in early minimally invasive treatment of severe acute pancreatitis to further verification the therapeutic effects and support for the further experimental and clinical application.Methods:Using severe acute pancreatitis model in rats, change the way of administration of protease inhibitor, and to carry on the early peritoneal lavage, evaluated in ulinastatin lavage concentration, survival time, important organs function, systemic inflammatory response. Using severe acute pancreatitis model in mini pig, application of interventional ultrasound technique to achieve peripancreatic drug lavage, further verify the therapeutic effect and mechanism.Results:In rats with severe acute pancreatitis model, ulinastatin peritoneal lavage had the best effect than the other. ①In survival time:the median survival time of the middle dose group was the longest, and the results compared with other experimental group were model group (SAP) (P< 0.01), saline lavage group (SL) (P< 0.01) and ulinastatin injection group (IU) (P< 0.01), low dose group (P< 0.05), high dose group (P> 0.05), super high dose group (P< 0.05), late ulinastatin lavage group (P< 0.05). ②pancreatic function: Ulinastatin peritoneal lavage group (UL) reduce the level of amylase best, and the results compared with other group were SAP group (P< 0.01), SL group (P< 0.01), IU group (P< 0.01); UL group reduce the level of lipase best, and the results compared with other group were SAP group (P< 0.01), SL group (P< 0.01), IU group (P< 0.01). ③Liver function: UL group reduce the level of alanine aminotransferase (ALT) best, and the results compared with other group were SAP group (P< 0.01), SL group (P> 0.05), IU group (P< 0.05); UL group reduce the level of aspartate aminotransferase (AST) best, and the results compared with other group were SAP group (P< 0.01), SL group (P> 0.05), IU group (P> 0.05). ④Renal function:UL group decreased creatinine (CR) effect best, and the results compared with other group were SAP group (P< 0.01), SL group (P> 0.05), IU group (P< 0.01); UL group reduce the urea (UR) best, and the results compared with other group were SAP group (P< 0.01), SL group (P< 0.05), IU group (P< 0.01). ⑤The troponin T:UL reduced the level of troponin T the best, and the results compared with other group were SAP group (P< 0.01), SL group (P< 0.01), IU group (P< 0.01). ⑥The inflammatory factor:UL group decreased IL-1 had the best effect, and the results compared with other group were SAP group (P< 0.01), SL group (P< 0.05). IU group (P< 0.05):UL group decreased IL-6 had the best effect, and the results compared with other group were SAP group (P< 0.01), SL group (P< 0.01), IU group (P< 0.01); UL group increased IL-10 has the best effect, and the results compared with other group were SAP group (P< 0.05), SL group (P< 0.01), IU group (P< 0.05); UL group decreased TNF-a has the best effect, and the results compared with other group were SAP group (P< 0.05), the SL group (P< 0.01), IU group (P< 0.05).In severe acute pancreatitis model of mini pigs, by ultrasound guided renal week effusion puncture and trendelenburg position, lavage fluid can be accumulation in peripancreatic, supine position, effusion from perirenal catheter, so achieved the peripancreatic region of lavage. In the whole experiment observation interval, ulinastatin lavage group(UL) get the best effect. ①The pancreatic function:in the whole observation interval of 1-6h, UL group increased amylase and lipase was the least, the results of amylase and lipase increased compared with the model group (SAP) were 1～4h amylase(P< 0.01) and lipase (P< 0.01),4～6h amylase (P< 0.01), lipase (P< 0.01); the results compared with saline group (SL) were 1～4h amylase(P< 0.01), lipase (P< 0.01), 4-6h amylase(P< 0.01) and lipase(P< 0.05); the results compared with ulinastatin injection group (IU) were 1～4h amylase (P< 0.01), lipase (P< 0.01),4-6h amylase(P< 0.01), lipase (p>0.05). ②The liver function:in the whole observation interval of 1～6h, the levels of ALT and AST increased in UL group were the least, the results of ALT and AST increased compared with the group (SAP) were 1～4h ALT (P> 0.05), AST (P< 0.05),4～6h ALT (P< 0.01), AST (P< 0.01); the results compared with saline group (SL) were 1～4h ALT (P> 0.05), AST (P> 0.05),4-6h ALT (P< 0.05), AST (P> 0.05); the results compared with ulinastatin injection group (IU) were 1～4h ALT (P> 0.05), AST (P < 0.05),4～6h ALT (P> 0.05), AST (P< 0.05). ③The kidney function:in the 1～6 hours throughout the observation interval, the levels of CR and UR increased the least, the results of CR and UR increased compared with the group (SAP) were 1～4 h CR(P< 0.01), UR (P < 0.01),4～6h CR (P< 0.05), UR(P> 0.05); the results compared with the group (SL) were 1～4 h CR (P> 0.05) and UR (P> 0.05),4～6h CR (P< 0.05) and UR (P> 0.05); the results compared with the group (IU) were 1～4h CR (P> 0.05), UR (P> 0.05),4～6h CR(P< 0.01), UR (P> 0.05). ④he inflammatory factor:in the whole observation interval of 1-6h, the level of IL-6 increased and the level of IL-10 decreased in UL group were the least, the results of IL-6 increased and IL-10 decreased compared with the group (SAP) were 1-4h IL-6 (P< 0.01), IL-10 (P< 0.01).4～6h IL-6 (P< 0.01), IL-10 (P< 0.01); the results compared with the SL group were 1～4h IL-6 (P< 0.01), IL-10 (P< 0.01),4～6h IL-6 (P> 0.05), IL-10 (P< 0.01); the results compared with the IU group were 1～4h IL-6 (P> 0.05), IL-10 (P> 0.05),4～6h IL-6 (P< 0.01), IL-10 (P< 0.01).Conclusion:Early ulinastatin peritoneal lavage can effectively improve the severe acute pancreatitis in rats of inflammatory factors, effectively protect the function of important organs and alleviate the damage of pancreatic tissue, significantly prolonged the median survival time and the therapeutic effect superior conventional saline peritoneal lavage and ulinastatin intravenous injection. Therapeutic opportunity may play an important factors on therapeutic effect of protease inhibitor peritoneal lavage in severe acute pancreatitis and the earlier the better.Early ultrasound guided minimally invasive interventional catheterization around renal combined with postural changes can achieve early peripancreatic regional drug lavage for severe acute pancreatitis. To further validate the early peripancreatic regional drug lavage with ulinastatin in the treatment of severe acute pancreatitis still has better effect and higher value in clinical application.