2000 Volume 11 Issue 9 Pages 428-436
Cytokines such as interleukin (IL)-6 and IL-8 may be key mediators in the development of organ failure induced by severe acute pancreatitis. We measured arterial plasma and peritoneal lavage fluid (PLF) levels of IL-6 and IL-8 in 6 patients with severe acute pancreatitis diagnosed based on criteria in Japanese patients. Peritoneal lavage was conducted for about 7 days to remove necrotic tissues and mediators released into the abdominal cavity using a fluid consisting of bicarbonate Ringer solution (SubloodTM) and ulinastatin (UTI: potent protease inhibitor; Mochida Pharm, Japan). Continuous infusion of UTI with an antibiotic (imipenam) to the celiac artery was also conducted in all patients. The PLF take-up ratio instilled was 85-90%, so we used this ratio to standardize cytokine levels. Statistical analysis was done by ANOVA with Scheffe's F-test (p<0.05). This study was approved by the Ethics Committee. Extremely high levels of IL-6 and IL-8 in PLF declined sharply after lavage but levels of both in arterial plasma decreased gradually over a period of 5 days. Differences between arterial plasma and PLF decreased markedly, associated with a rapid decrease in lactate dehydrogenase (LDH), an indicator of tissue damage, in PLF. All patients treated with these procedures recovered completely. These results suggest that peritoneal lavage as presented here, which is superior in outcome to those reported previously, is the treatment of chice for patients with severe pancreatitis, and indicate that early reduction of cytokine differences between plasma and the peritoneal cavity is beneficial in the treatment of acute severe pancreatitis.
