Percutaneous ultrasound-guide drainage in complications of acute pancreatite
Percutaneous ultrasound-guide drainage in complications of acute pancreatite
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DOI：
10.1016/j.anchir.2004.09.006
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发表时间：
2004-11-01
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影响因子：
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通讯作者：
Flament, JB
中科院分区：
文献类型：
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作者：
Delattre, JF;Chazal, NL;Flament, JB
研究的目的。目的：报告外科医生经皮超声引导引流治疗急性胰腺炎（AP）并发症的结果，并确定该技术在重症AP患者治疗中的作用和方法。-从1986年至2001年，59例患者纳入本回顾性研究。所有患者最初都有严重坏死性AP（平均Ranson评分= 4.1；范围：2-7）。解剖病变包括胰腺脓肿6例，坏死53例（按Balthazar分级D期17例，E期36例）。坏死感染42例，无菌11例。在超声引导和局部麻醉下采用小直径引流管引流（7-14 French）。结果- AP发病后平均23天进行引流。47例（80%）患者（41例感染坏死，6例局部脓肿）经细针穿刺证实感染。1例患者抽吸液培养阴性，但坏死感染（1例假阴性）。11例抽吸液培养阴性，坏死无菌。9例青少年患者（32%）未手术治愈：感染坏死组7例（16%），无菌坏死组6例（55%），脓肿组6例（100%）。40例（68%）患者随后进行了坏死切除术，其中8例（14%）死亡。除1例采用分流造口术外，其余20例（34%）自行愈合。在16例（27%）胰腺瘘中，6例需要后续介入治疗。-在选定的患者中，经皮引流可作为手术的替代方法，死亡率为14%。后续坏死切除术的高发生率提示应使用直径较大的引流管，可能与持续冲洗有关。(C) 2004 Elsevier SAS。我们的权利储备。
Aim of the study.-To report results of percutaneous ultrasound-guided drainage, performed by a surgeon, in the treatment of complications of acute pancreatitis (AP), and to determine the role of this technique in the therapeutic armamentarium of severe AP.Patients and Methods.- From 1986 to 2001, 59 patients were included in this retrospective study. All patients initially had severe necrotizing AP (mean Ranson score = 4.1; range : 2-7). Anatomical lesions included pancreatic abscess in 6 patients and necrosis in 53 (17 stage D and 36 stage E according to Balthazar's classification). Necrosis was infected in 42 and sterile in 11 respectively. Drainage was performed under ultrasound guidance and local anaesthesia using small-diameter drains (7-14 French).Results- Drainage was performed on average 23 days after onset of AP. Infection was proven by fine-needle aspiration in 47 (80 %) patients (41 infected necrosis and 6 localized abscess). In one patient, culture of aspirated fluid was negative but necrosis was,infected (one faulse negative). Culture of aspirated fluid was negative and necrosis was sterile in 11 patients.. Nine teen (32%) patients healed without subsequent surgery: 7 (16%) in the infected necrosis group, 6(55%) in the sterile necrosis group, and 6 (100%) in the abscess group. Fourty (68%) patients had subsequent necrosectomy including 8(14 %) who died. Twenty(34 %) digestive fistulas healed spontaneously, except one treated by diversion stomia. Of the 16 (27 %) pancreatic fistulas, 6 needed subsequent interventional treatment.Conclusion.- In selected patients, percutaneous drainage can represent an alternative-to surgery with a 14% mortality rate. The high rate of subsequent necrosectomy suggests that drains with larger diameter, possibly associated with continuous irrigation, should be used. (C) 2004 Elsevier SAS. Tous droits reserves.