Step-up approach to infected necrotising pancreatitis: A 20-year experience of percutaneous drainage in a single centre
Step-up approach to infected necrotising pancreatitis: A 20-year experience of percutaneous drainage in a single centre
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DOI：
10.1016/j.dld.2011.02.020
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发表时间：
2011-06-01
影响因子：
4.5
通讯作者：
Haracic, Bahrija
中科院分区：
文献类型：
--
作者：
Zerem, Enver;Imamovic, Goran;Haracic, Bahrija
目的：评价阶梯式手术治疗感染性坏死性胰腺炎的疗效。方法：回顾分析1989~2009年86例经手术治疗的感染性坏死性胰腺炎患者。感染是通过检查吸入的物质或在对比增强的计算机断层扫描中存在游离胰腺气体来确认的。所有患者最初都尝试了保守治疗；当保守治疗失败时，进行经皮导管引流；只有在临床没有改善的情况下，才计划手术。结果：15例患者(17.4%)仅行保守治疗获得成功。69例行经皮导管引流术(80.2%)。死亡8例(9.3%)，其中2例在第1周未引流或手术，6例经皮导管引流和手术后死亡。中转手术11例(12.8%)。器官功能衰竭59例(68.6%)，多器官功能衰竭25例(29.1%)。中位(四分位数范围)住院和留置导尿管时间分别为13(9-47)天和15(7-34)天。每例患者发生导管问题2.61例，更换导管1.68例。结论：阶梯式治疗感染坏死性胰腺炎是一种安全有效的治疗方法。对于大多数患者，经皮引流可以避免手术的需要。(C)2011年编辑意大利胃肠病学S.r.L.爱思唯尔有限公司出版。保留所有权利。
Aim: To evaluate the efficacy of step-up approach to infected necrotising pancreatitis.Methods: Retrospective analysis of 86 patients treated by step-up approach from 1989 to 2009. Infection was confirmed by examination of aspirated material or by presence of free pancreatic gas at contrast-enhanced computed tomography. Conservative treatment was initially attempted in all patients; percutaneous catheter drainage was performed when conservative therapy failed; surgery was planned only if no clinical improvement was observed. Primary outcome was mortality.Results: Fifteen patients (17.4%) were successfully treated with conservative treatment only. Percutaneous catheter drainage was performed in 69 (80.2%). Eight patients (9.3%) died, two at week 1 without drainage or surgery and six after percutaneous catheter drainage and surgery. Eleven patients were converted to surgery (12.8%). Organ failure occurred in 59/86(68.6%) and multiorgan failure in 25/86(29.1%). Median (interquartile ranges) hospital stay and catheter dwell times were 13 (9-47) and 15(7-34) days, respectively. There were 2.61 catheter problems and 1.68 catheter changes per patient.Conclusions: The step-up approach is an effective and safe strategy for the treatment of infected necrotising pancreatitis. Percutaneous drainage can avert the need for surgery in the majority of patients. (C) 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.