Double-catheter lavage combined with percutaneous flexible endoscopic debridement for infected pancreatic necrosis failed to percutaneous catheter drainage.
Double-catheter lavage combined with percutaneous flexible endoscopic debridement for infected pancreatic necrosis failed to percutaneous catheter drainage.
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双导管灌洗联合经皮软镜清创术治疗感染性胰腺坏死经皮导管引流失败
DOI：
10.1186/s12876-017-0717-3
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发表时间：
2017-12-08
影响因子：
2.4
通讯作者：
Lei YP
中科院分区：
文献类型：
--
作者：
Liu P;Song J;Ke HJ;Lv NH;Zhu Y;Zeng H;Zhu Y;Xia L;He WH;Li J;Huang X;Lei YP
感染性胰腺坏死（Infected pancreatic necrosis，IPN）是急性胰腺炎的严重局部并发症，病死率高.包括经皮导管引流（PCD）在内的微创治疗已成为IPN的首选方法，而不是传统的开放性坏死切除术。然而，PCD失败后，双导管灌洗结合经皮柔性内镜清创术的疗效是未知的相比，手术necrosectomy.MethodsA共27例IPN患者与失败的PCD之间的2014年1月和2015年12月，在这个回顾性队列研究。15例患者接受了双导管灌洗联合经皮柔性内镜清创术，12例患者接受了开放性坏死切除术。主要终点是主要并发症或死亡的复合终点。次要终点包括死亡率、主要并发症发生率、ICU住院时间和总住院时间。（8/15，53%）明显低于开放性坏死组（11/12，92%）（RR = 1.71，95%CI = 1.04 ~ 2.84，P < 0.05）。两组病死率比较差异无统计学意义（0% vs. 17%，P = 0.19），但实验组新发多器官功能衰竭发生率和ICU住院时间明显低于开放性坏死切除组（13% vs. 58%，P = 0.04; 0 vs. 17，P= 0.02）。经皮清创术后仅40%的患者需要入住ICU，明显低于手术患者（83%;P< 0.05）。结论双导管灌洗联合经皮软内镜清创术治疗PCD失败后IPN患者上级有效性、安全性和方便性优于开放性坏死切除术。
BackgroundInfected pancreatic necrosis (IPN) is a serious local complication of acute pancreatitis, with high mortality. Minimally invasive therapy including percutaneous catheter drainage (PCD) has become the preferred method for IPN instead of traditional open necrosectomy. However, the efficacy of double-catheter lavage in combination with percutaneous flexible endoscopic debridement after PCD failure is unknown compared with surgical necrosectomy.MethodsA total of 27 cases of IPN patients with failure PCD between Jan 2014 and Dec 2015 were enrolled in this retrospective cohort study. Fifteen patients received double-catheter lavage in combination with percutaneous flexible endoscopic debridement, and 12 patients underwent open necrosectomy. The primary endpoint was the composite end point of major complications or death. The secondary endpoint included mortality, major complication rate, ICU admission length of stay, and overall length of stay.ResultsThe primary endpoint occurrence rate in double-catheter lavage in combination with percutaneous flexible endoscopic debridement group (8/15, 53%) was significantly lower than that in open necrosectomy group (11/12, 92%) (RR = 1.71, 95% CI = 1.04 – 2.84,P< 0.05). Though the mortality between two groups showed no statistical significance (0% vs. 17%,P= 0.19), the rate of new-onset multiple organ failure and ICU admission length of stay in the experimental group was significantly lower than that in open necrosectomy group (13% vs. 58%,P= 0.04; 0 vs. 17,P= 0.02, respectively). Only 40% of patients required ICU admission after percutaneous debridement, which was markedly lower than the patients who underwent surgery (83%;P< 0.05).ConclusionsDouble-catheter lavage in combination with percutaneous flexible endoscopic debridement showed superior effectiveness, safety, and convenience in patients with IPN after PCD failure as compared to open necrosectomy.
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影响因子：
29.4
作者：
Petrov, Maxim S.;Shanbhag, Satyanarayan;Windsor, John A.
通讯作者：
Windsor, John A.
DOI：
10.1016/j.anchir.2004.09.006
发表时间：
2004-11-01
期刊：
ANNALES DE CHIRURGIE
影响因子：
--
作者：
Delattre, JF;Chazal, NL;Flament, JB
通讯作者：
Flament, JB
影响因子：
65.1
作者：
van Grinsven, Janneke;van Santvoort, Hjalmar C.;Besselink, Marc G.
通讯作者：
Besselink, Marc G.
影响因子：
4.5
作者：
Zerem, Enver;Imamovic, Goran;Haracic, Bahrija
通讯作者：
Haracic, Bahrija
影响因子：
24.5
作者：
Seifert, H.;Biermer, M.;Roesch, T.
通讯作者：
Roesch, T.