The efficacy and efficiency of stent-assisted percutaneous endoscopic necrosectomy for infected pancreatic necrosis: a pilot clinical study using historical controls
The efficacy and efficiency of stent-assisted percutaneous endoscopic necrosectomy for infected pancreatic necrosis: a pilot clinical study using historical controls
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支架辅助经皮内镜坏死切除术治疗感染性胰腺坏死的疗效和效率：使用历史对照的初步临床研究
DOI：
10.1097/meg.0000000000002127
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发表时间：
2021-12-01
影响因子：
2.1
通讯作者：
Windsor, John
中科院分区：
文献类型：
--
作者：
Ke, Lu;Li, Gang;Windsor, John
目的微创介入治疗已成为感染性胰腺坏死（IPN）的标准治疗方法。尽管最近的研究显示，内窥镜方法的临床优势比手术方法小，但当内窥镜治疗不适用时，经皮技术仍然有作用。支架辅助经皮内镜下坏死切除术（SAPEN）是外科坏死切除术的替代选择，但该手术的理论优势尚未得到证实。本研究旨在报告SAPEN在IPN患者中的疗效和效率。方法：这是一项回顾性、历史对照、队列研究。对2015年1月至2018年12月入住我中心的所有IPN患者进行了合格性筛选。2015年1月至2017年10月期间入院的患者为历史对照，此后入院的患者接受额外的自膨式金属支架（SEMS）治疗。主要终点是严重并发症和/或死亡的复合终点。还比较了其他结局，包括主要终点的各个组成部分、新发脓毒症、ICU和住院时间以及胰瘘。结果纳入73例历史对照患者和37例SAPEN患者进行分析。SAPEN手术的引入未能降低主要终点的发生率（35% vs 52%，P = 0.095）。然而，在SAPEN组中观察到住院时间显著缩短（38天vs 48天，P = 0.035）和新发脓毒症发生率较低（35% vs 56%，P = 0.037）。结论SEMS在经皮内镜下坏死清除术中的应用缩短了住院时间，减少了新发脓毒症的发生，并允许早期坏死清除。
Objectives Minimally invasive interventions have become standard treatment for infected pancreatic necrosis (IPN). Despite the marginal clinical advantage of endoscopic approaches over the surgical approach shown in recent studies, percutaneous techniques still have a role when endoscopic treatment is not indicated. Stent-assisted percutaneous endoscopic necrosectomy (SAPEN) is an alternative option for surgical necrosectomy, but the theoretical advantages to this procedure remain unproven. This study aimed to report the efficacy and efficiency of SAPEN in patients with IPN. Methods This is a retrospective, historically-controlled, cohort study. All IPN patients admitted to our center from January 2015 to December 2018 were screened for eligibility. Patients admitted between January 2015 and October 2017 were historical controls, and patients admitted thereafter were treated with additional self-expandable metal stent (SEMS). The primary endpoint was a composite of major complications and/or death. Other outcomes, including individual components of the primary endpoint, new-onset sepsis, length of ICU and hospital stay, and pancreatic fistula, were also compared. Results There were 73 historical-control patients and 37 patients who had SAPEN included for analysis. The introduction of the SAPEN procedure failed to reduce the incidence of the primary endpoint (35 versus 52%, P = 0.095). However, significantly shorter hospital stay (38 versus 48 days, P = 0.035) and lower incidence of new-onset sepsis were observed in the SAPEN group (35 versus 56%, P = 0.037). Conclusion The application of SEMS in percutaneous endoscopic necrosectomy procedures shortened hospital stay, decreased new-onset sepsis, and allowed earlier necrosectomy.