Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis
Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis
复制标题
DOI：
10.1002/bjs.7304
复制
发表时间：
2011-01-01
影响因子：
9.6
通讯作者：
Gooszen, H. G.
中科院分区：
文献类型：
--
作者：
van Baal, M. C.;van Santvoort, H. C.;Gooszen, H. G.
背景：评价经皮导管引流（PCD）在（感染性）坏死性胰腺炎患者中的作用。方法：进行系统的文献检索。纳入标准为：坏死性胰腺炎患者连续队列，接受PCD作为胰腺周围收集的主要治疗；PCD的适应症为（疑似）感染性坏死或有症状的无菌性胰腺坏死；报告的结果包括胰腺周围收集物感染的百分比，需要额外的手术切除，并发症和死亡。排除标准为：少于5例患者的队列；队列包括慢性胰腺炎患者；选定的急性胰腺炎患者亚组，如假性囊肿、胰腺脓肿和/或纯无菌胰腺坏死患者；PCD与另一种微创策略相结合的队列研究，PCD单独治疗的结果未单独报道。结果：11项研究，384例患者符合纳入标准。只有一项研究是随机对照试验；其他大多数是回顾性病例系列。四项研究报告了PCD前存在器官衰竭；116名患者中有67.2%出现这种情况。384例患者中有271例（70.6%）确诊为感染性坏死。384例患者中有214例（55.7%）在PCD后不需要再进行手术切除。并发症以胰内瘘和胰外瘘为主。总死亡率为17.4%（384名患者中有67人）。11项研究中有9项分别报告了接受PCD的感染性坏死患者的死亡率；这一群体的死亡率为15.4%（175人中的27人）。结论：相当数量的PCD患者可以在不需要手术切除的情况下得到治疗。
Background: The role of percutaneous catheter drainage (PCD) in patients with (infected) necrotizing pancreatitis was evaluated.Methods: A systematic literature search was performed.Inclusion criteria were: consecutive cohort of patients with necrotizing pancreatitis undergoing PCD as primary treatment for peripancreatic collections; indication for PCD either (suspected) infected necrosis or symptomatic sterile pancreatic necrosis; and outcomes reported to include percentage of infected peripancreatic collections, need for additional surgical necrosectomy, complications and deaths.Exclusion criteria were: cohort of fewer than five patients; cohort included patients with chronic pancreatitis; selected subgroup of patients with acute pancreatitis studied, such as those with pseudocysts, pancreatic abscesses and/or exclusively sterile pancreatic necrosis; and cohort in which PCD was combined with another minimally invasive strategy and results for PCD alone not reported separately.Results: Eleven studies, including 384 patients, fulfilled the inclusion criteria.Only one study was a randomized controlled trial; most others were retrospective case series.Four studies reported on the presence of organ failure before PCD; this occurred in 67.2 per cent of 116 patients.Infected necrosis was proven in 271 (70.6 per cent) of 384 patients.No additional surgical necrosectomy was required after PCD in 214 (55.7 per cent) of 384 patients.Complications consisted mostly of internal and external pancreatic fistulas.The overall mortality rate was 17.4 per cent (67 of 384 patients).Nine of 11 studies reported mortality separately for patients with infected necrosis undergoing PCD; the mortality rate in this group was 15.4 per cent (27 of 175).Conclusion: A considerable number of patients can be treated with PCD without the need for surgical necrosectomy.