Controlled Open Lesser Sac Drainage for Pancreatic Abscess
Controlled Open Lesser Sac Drainage for Pancreatic Abscess
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控制性开放小囊引流治疗胰腺脓肿
DOI：
10.1097/00000658-198606000-00003
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发表时间：
1986
影响因子：
9
通讯作者：
W. Remine
中科院分区：
文献类型：
--
作者：
J. Pembérton;J. Becker;R. Dozois;D. Ilstrup;W. Remine
最近的研究表明，胰腺脓肿患者的发病率和死亡率可以减少，如果控制开放小囊引流（COLD），而不是传统的封闭引流（CD）。为了确定采用COLD治疗的患者的结局是否更好，我们对1966年至1985年间81例胰腺脓肿手术治疗的连续患者进行了研究。17例患者采用COLD，包括脓肿腔初步广泛清创、开放填塞、抽吸引流、重复手术更换填塞物和灌洗，64例患者采用CD。治疗组之间的年龄、性别、胰腺炎病因以及放射学和实验室检查结果相似。然而，COLD组中明显全身性脓毒症患者和基于与胰腺炎易感性发作相关的兰森体征的死亡风险增加的患者数量高于CD组（分别为100% vs. 61%和92% vs. 44%;两者均为p ≤ 0.05）。COLD和CD患者的总死亡率分别为18%和44%（p < 0.05）。然而，在死亡风险增加的患者中（阳性兰森体征≥ 3），COLD和CD后的死亡率分别为18%和70%（p < 0.05）。对于重症胰腺炎（兰森征5≥ 3）诱发胰腺脓肿并伴有明显全身性脓毒症的患者，控制性开放引流可能是治疗的选择。
Recent studies suggest that morbidity and mortality in patients with pancreatic abscess can be lessened if controlled open lesser sac drainage (COLD) is performed rather than traditional closed drainage (CD). To determine whether the outcome of patients treated by COLD was more favorable, 81 consecutive patients with pancreatic abscess managed surgically between 1966 and 1985 were studied. COLD, consisting of initial wide debridement of the abscess cavity, open packing, suction drainage, repeated operative pack changes, and lavage was used in 17 patients and CD in 64 patients. Age, sex, etiology of pancreatitis, and radiographic and laboratory findings were similar between treatment groups. However, the number of patients with overt systemic sepsis and those at increased risk of death based on Ranson signs associated with the predisposing episode of pancreatitis were greater in the COLD group than in the CD group (100% vs. 61%, and 92% vs. 44%, respectively; p ≤ 0.05 for both). Overall mortality in COLD and CD patients was 18% and 44%, respectively (p < 0.05). However, in patients at increased risk of death (positive Ranson signs ≥ 3), mortality after COLD and CD was 18% and 70%, respectively (p < 0.05). Controlled open drainage may be the treatment of choice in patients with pancreatic abscess precipitated by severe pancreatitis (Ranson signs 5≥ 3) and associated with overt systemic sepsis.