Management of colonic fistulas in patients with infected pancreatic necrosis being treated with a step-up approach
Management of colonic fistulas in patients with infected pancreatic necrosis being treated with a step-up approach
复制标题
采用升级方法治疗感染性胰腺坏死患者的结肠瘘管理
DOI：
10.1016/j.hpb.2020.03.021
复制
发表时间：
2020-12-01
期刊：
影响因子：
2.9
通讯作者：
Li, Wei-qin
中科院分区：
文献类型：
--
作者：
Gao, Lin;Zhang, Jing-zhu;Li, Wei-qin
背景资料：结肠瘘是急性坏死性胰腺炎（ANP）的一种潜在的致命并发症，特别是在感染性胰腺坏死（IPN）患者中。本研究的目的是评估的可行性，逐步的方法，包括经皮导管引流（PCD）和持续负压冲洗（CNPI）在一组患者与结肠fistulation.Methods：回顾性分析的前瞻性收集的数据进行。方法：回顾性分析2010年1月至2017年1月间我院收治的1750例急性胰腺炎合并结肠瘘患者的临床资料。在这些患者中，711例（41%）发生IPN，132例（19%）出现结肠瘘。所有患者均采用逐步增加的方法，47%的患者避免了手术。需要手术治疗的患者的死亡率（37%）高于非手术治疗的患者（19%），总体死亡率为29%。在保守治疗的患者中，92%有自发关闭的fistulation.Conclusion：结肠瘘是不是一个罕见的并发症，在ANP发生在19%的患者IPN在目前的研究。采用阶梯式手术治疗结肠瘘是安全有效的，近一半的患者可以避免手术。接收日期2020年1月6日;接受日期2020年3月20日
Background: Colonic fistula is a potentially fatal complication in acute necrotizing pancreatitis (ANP), especially in patients with infected pancreatic necrosis (IPN). The aim of this study was to evaluate the feasibility of a step-up approach including percutaneous catheter drainage (PCD) and continuous negative pressure irrigation (CNPI) in a group of patients with colonic fistula.Methods: A retrospective review of a prospectively collected data was performed. Data were extracted for patients complicated by colonic fistula from January 2010 to January 2017.Results: A total of 1750 patients were admitted with ANP during the study period. Of these patients, 711 (41%) developed IPN and colonic fistula was present in 132 (19%). A step-up approach was adopted for all patients, with 47% avoiding surgery. The mortality in patients requiring surgery (37%) was higher than that in patients managed non-surgically (19%) constituting an overall mortality rate of 29%. In patients managed conservatively, 92% had spontaneous closure of the fistula.Conclusion: Colonic fistula is not a rare complication in ANP occurring in 19% of patients with IPN in the current study. A step-up approach was effective and safe in managing colonic fistula and surgery could be obviated in nearly half of the patients. Received 6 January 2020; accepted 20 March 2020