Evaluation of Clinical Efficcacy of Complex Treatment for Necrotic Pancreatitis Using Cord Blood Stem Cell Transplantation and Cryopreserved Cord Tissue

A.B. Kebkalo

Abstract


The objective of the paper is to evaluate the efficiency of complex treatment of necrotic pancreatitis using cord blood stem cell transplantation and cryopreserved cord tissue. According to our proposed working classification based on the classification of the International Working Group (2007–2009) the groups of patients were dived to those who have been diagnosed with aseptic or infected necroses of the pancreas and parapancreatic fiber. The patients hadn’t any allergic reactions during application of intravenous stem cells of cord blood and temporary parapancreatic transplantation of cord tissue. The body temperature of 51 patients of 73 (69.8 %) increased to 39 °C during 3–5 days. The temperature reaction normalized after cell and tissue therapy ending. The minimally invasive interventions and cord blood stem cell transplantation were the most effective in 33 (45.2 %) patients with necrotic pancreatitis that promoted the recovery. In 40 of 73 (54.8 %) patients after the minimally invasive interventions and cord blood introduction the surgery was performed to remove necrotic tissues in the pancreas and parapancreatic fiber. The cord tissue was used during open operation. For the patients the drainage under ultrasound control was the first step of the surgical treatment aimed at stabilization, detoxification and preparation of the patient for open surgical intervention. In the control group of patients with necrotic pancreatitis of 106 patients for 29 (27.4 %) minimally invasive interventions were the most effective and ended with recovery. The control of patients’ state during the treatment after puncture drainage of fluid formations made it possible to determine the necessity of the surgery taking into account the failure of therapeutic measures in 77 of 106 patients (72.6 %). The incidence of postoperative complications in the control group (106 patients) stated 51 (48.1 %) cases. At the same time the complications were diagnosed in 35 (68.6 %) patients with necrotic parapancreatitis but in patients with necrotic pancreatitis — in 16 (31.4 %). The complications were developed 2.18 (p < 0.05) times more often in patients with the spread of necrotic process to the retroperitoneal space. The most common complications were: the occurrence of pancreatic fistula in 18 (16.9 %) patients, the gastrointestinal bleeding in 8 (7.5 %) patients, the arrosive bleeding from omental bursa in 7 (6.6 %) patients. The occurence of postoperative complications in the main group (73 patients) was 18 (24.7 %) cases. At the same time the complications were diagnosed in 11 (61.1 %) patients with necrotic parapancreatitis but in patients with necrotic pancreatitis — in 7 (38.9 %). In patients with the spread of necrotic process to the retroperitoneal space the complications were developed 1.57 times more often. The most common complications were: the occurrence of pancreatic fistula in 4 (5.4 %) patients, the adhesive intestinal obstruction in 3 (4.1 %) patients and intestinal fistula in 2 (2.7 %) patients. By the standard treatment the mortality of patients with necrotic pancreatitis was the average 19.8 %, with the use of biotechnology 9.6 %, which is reduced to 2.06 (p < 0.05) times. The average bed-day stay of patients of the control group was 30.2 days and 24.5 days in the main group, which is in 1.23 (p < 0.05) times less. By comparative analysis it was determined that in the main group the incidence of postoperative complications was 1.95 (p < 0.05) times less than in the control group. Pancreatic fistula of the main group patients was 3.12 (p < 0.01) times less and the gastrointestinal bleeding was 2.77 (p < 0.05) times less than in the control group. Such severe complication as arrosive hemorrhage of omental bursa was observed 4.71 (p < 0.01) times less in the main group than in the control group. The development of disseminated intravascular coagulation in the main group patients identified 3.48 (p < 0.01) times less than in the control group patients. After conducted observation one can state that the temporal parapancreatic transplantation of cord tissue and cord blood stem cell transplantation in patients with necrotic pancreatitis leads to the inhibition of cystogenesis in the pancreas. Pancreas cyst were detected in 6.1 % of cases compared with retrospective analysis data (46.6 %) and with published data where the percentage of cyst formation is from 30 to 50 %. During the observation of the patients after temporal parapancreatic transplantation of cord tissue and t cord blood stem cell transplantation, it was revealed that the activity of alkaline phosphatase increased in the first 3 and 6 months and by 1.43 (p < 0.05) and 2.06 (p < 0.01) times and in 1 year decreased gradually, but remained increased to 23.7 % (p < 0.05). This fact shows the activity of stem cells of cord blood during a year after transplantation.


Keywords


necrotic pancreatitis; cord blood stem cell transplantation; cryopreserved cord tissue

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DOI: https://doi.org/10.22141/1997-2938.2.21.2013.87486

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