Study On The Value Of Embryonic Natural Orifice Transluminal Endoscopic Surgery (E-NOTES) By Flexible Endoscope In Patients With Severe Acute Pancreatitis Associated With Multiple Organ Dysfunction Syndrome

This study included two parts. The first part is the experimental research of multiple organ injury induced by pancreatitis associated ascetic fluid (PAAF) in mice. The second part is the clinical study of the effect of peritoneal lavage and dialysis by embryonic natural orifice transluminal endoscopic surgery (E-NOTES) by flexible endoscope in patients with severe acute pancreatitis associated with multiple organ dysfunction syndrome.Part One. Experimental research of multiple organ injury induced by pancreatitis associated ascetic fluid in miceObjective:To investigate the injury of multiple organ induced by pancreatitis associated ascetic fluid (PAAF) in mice.Methods:53 SPF-Kunming mice were randomly divided into three groups:group A, pancreatitis associated ascetic fluid (PAAF) was injected into the peritoneal cavity, group B, cirrhotic ascites was injected into the peritoneal cavity, group C, normal saline was injected into the peritoneal cavity. All three drugs were injected twice a day for 5 days with a dose of 2ml for each one respectively. The mice were sacrificed at 5h after the last injection per-day. The pathological changes of intestines, lung, liver and pancreas were observed by microscope.Results:Our results of the study showed that the injury of intestines, liver, lung and pancreas were observed in group A, and the degree of injury was increased concomitantly with the time of administration. In group B and C, there was no abnormal condition for the pathologic examination of main organs.Conclusion:Our study demonstrated that PAAF contained a large numbers of toxic substances, can induce multiple organ injury, and the degree of injury was increased concomitantly with the time of administration.Part Two. The effect of peritoneal lavage and dialysis by E-NOTES by flexible endoscope in patients with severe acute pancreatitis associated with multiple organ dysfunction syndromeObjective:To investigate the effect of peritoneal lavage and dialysis by E-NOTES by flexible endoscope in patients with severe acute pancreatitis (SAP) associated with multiple organ dysfunction syndrome.Methods:The study was conducted during June.2004-December.2010 on a sample consisting of 76 subjects with SAP. All patients were received peritoneal lavage and dialysis by E-NOTES by flexible endoscope in base of routine treatment. The release time of peritoneal irritation sign, the duration of intra-abdominal hypertension, bowel sound, APACH-II scores and prognosis of the patients were evaluated. The levels of TNF-a, IL-6, IL-8 and CRP in serum, also, the concentrations of total protein, karyocyte, amylase and inflammatory factors in ascites/peritoneal lavage fluid were measured.Results:Seventy-two patients cured in 76 patients, the recovery rate is 94.7%, and 4 patients were transferred to the ICU and surgery, the average hospital stay was (15.53±5.77) d. Recovery time of bowel sound was (3.27±1.26) d, the release time of peritoneal irritation sign was (3.02±1.10) d, and the difference between before and after treatment was significance in intra-abdominal pressure (IAP) and APACH-II scores of the patients (P＜0.05). The levels of testing items in serum and ascites/peritoneal lavage fluid were decreased significantly during peritoneal lavage and dialysis.Conclusion:Continuous peritoneal lavage and dialysis by E-NOTES by flexible endoscope is a safe and effective method for patients with complications of SAP, especially in the early stages of the disease.