ПАТОМОРФОЛОГИЧЕСКАЯ ОЦЕНКА ЭФФЕКТИВНОСТИ РЕЗОНАНСНОЙ ЭЛЕКТРОСТИМУЛЯЦИИ ПРИ ТЯЖЕЛОМ ОСТРОМ ПАНКРЕАТИТЕ

Aim . Analysis of the dynamics of morphological changes in the intestinal wall under the influence of resonant electrical stimulation in the correction of intra-abdominal pressure and intestinal paresis in patients with severe acute pancreatitis. Materials and methods . The treatment outcome of 105 patients who were in surgical clinics for severe acute pancreatitis for the period 2015-2018 was analyzed. 2 study groups were formed: the main (n-62, group 1) and comparisons (n-43, group 2), comparable in age, sex and severity of condition. The treatment was carried  out in accordance with the regulatory documents of the Moscow City Health Department and NKR ROH. Additionally, the method of selective resonant digestive tract electrical stimulation was included in the medical arsenal of the 1st group for the prevention and correction of motor evacuation disorders and intra-abdominal hypertension. For enteral support, a jejunal feeding tube with endoscopic placement was used, and during the installation, a forceps biopsy of the mucosa of the duodenojejunal transition on the 1st and later on the 7th day of treatment was performed. Such manipulation made it possible to assess the degree of reduction of intra-abdominal hypertension (as a result of the therapy), as well as the restoration of the motor-evacuation function of the digestive tract in the study groups. Results . In total, we performed 47 biopsies of jejunum mucosa on 1 day from the start of treatment: in group 1 - in 32 patients (51.6%), in group 2 - in 15 patients (34.9%). Subsequently, on the 7th day, the same patients underwent repeated gastroscopy with examination of the area of the duodenojejunal transition and biopsy for repeated morphological evaluation of the obtained material. In the study groups, when analyzing the initial histological preparations, identical morphological changes were traced, which proved the common pathogenetic cascades and the universality of certain morphological findings. In the dynamics of treatment, there was a dissociation of the morphological picture of the study groups with a more torpid regression of interstitial, mainly submucosal edema, as well as the persistence of severe atrophy of the crypts and sites of desquamation of enterocytes. Based on intravital histological studies, we systematized the obtained data with a point estimate of the degree of morphological findings, which proved the degree of influence of early correction of intra-abdominal hypertension and the prevention of motor evacuation disorders in the study groups. Conclusion The early monitoring and elimination of intra-abdominal hypertension, as well as the restoration of adequate intestinal motility in severe acute pancreatitis by the method of selective resonant stimulation, is objectified by the dynamics of morphological changes during juvenile biopsies in comparison with the initial data at the start of the disease and treatment without the use of electrical stimulation technologies.