Application of ozone-oxygen mixture in patients with acute biliary pancreatitis and bile hypertension
Background. The purpose is to improve the surgical treatment of patients with acute biliary pancreatitis (ABP) and bile hypertension by applying an individual approach to the choice of decompression technology in the early phase of the disease and early prevention of infectious complications through the use of ozone-oxygen mixtures. Materials and methods. The study involved 70 patients (22 men and 48 women) with ABP and bile hypertension of different age groups (mean age — 57.2 years). In all patients, the biliary origin of pancreatitis was diagnosed according to the criteria of the Dutch Pancreatitis Study Group. An improved algorithm for surgical treatment was used in all patients, which consisted in an individual approach to the choice of decompression technology in the first 72 hours from the initial attack of abdominal pain regardless of the duration of hospitalization. The patients were divided into two groups according to the method used for early prevention of infectious complications, which consisted in the application of ozone-oxygen mixture. In patients of the first group (n = 32) after the elimination of biliary hypertension, the prevention of infectious complications was carried out by endobiliary administration of ozone-oxygen mixture dissolved in 0.9% NaCl with ozone concentration of 2–4 µg/ml, in patients of the second group (n = 38), only the advanced algorithm of surgical treatment of biliary hypertension was used. To detect possible damaging effects of the ozone-oxygen mixture on the bile duct, we examined the bile duct in 12 patients with ABP and bile hypertension, whose gallbladder was removed during the acute period of the disease. Results. Forty nine endoscopic fibrogastroduodenoscopies with papillosphincterotomy and lithotomy, 10 percutaneous transhepatic puncture drainages, 13 laparoscopic cholecystectomies with external drainage of extrahepatic bile ducts were performed (in 5 patients, laparoscopic choledochoscopy with lithotomy was done). Necrotic forms of acute pancreatitis developed in 11 (34.37 %) patients in the first group, of which 5 (45.45 %) were infected. The average duration of treatment in this group was 14.5 days, and the mortality rate was 6.25 %. In group 2, necrotic forms of acute pancreatitis developed in 15 (39.47 %) patients, of which 7 (46.6 %) were infected. The average duration of treatment in patients of the second group was 16.46 days, and the mortality rate was 10.5 %. Conclusions. The early prevention of infectious complications in patients with ABP and biliary hypertension combined with decompression surgical interventions to eliminate biliary hypertension in the first 72 hours from the onset of the disease makes it possible to reduce the incidence of necrotic and infected forms, the severity of the disease, the mortality rate and the length of stay in the hospital, in vitro does not cause alterative, degenerative or degenerative changes both on the cellular and tissue level in all structures of the ductus cysticus wall.
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