Percutaneous catheter drainage and negative pressure irrigation for severe acute pancreatitis (SAP) patients with infective pancreatic necrosis

( views:362, downloads:0 )
Author:
TONG Zhi-hui(Research Institute of General Surgery, Jinling Hospital, Medicine School of Nanjing University, Nanjing 210002, China)
WU Cong-ye(Research Institute of General Surgery, Jinling Hospital, Medicine School of Nanjing University, Nanjing 210002, China)
LI Wei-qin(Research Institute of General Surgery, Jinling Hospital, Medicine School of Nanjing University, Nanjing 210002, China)
LI Gang(Research Institute of General Surgery, Jinling Hospital, Medicine School of Nanjing University, Nanjing 210002, China)
ZHANG Lu-yao(Research Institute of General Surgery, Jinling Hospital, Medicine School of Nanjing University, Nanjing 210002, China)
NIE Yao(Research Institute of General Surgery, Jinling Hospital, Medicine School of Nanjing University, Nanjing 210002, China)
LI Ning(Research Institute of General Surgery, Jinling Hospital, Medicine School of Nanjing University, Nanjing 210002, China)
LI Jie-shou(Research Institute of General Surgery, Jinling Hospital, Medicine School of Nanjing University, Nanjing 210002, China)
Journal Title:
Chinese Journal of Pancreatology
Issue:
Volume 12, Issue 05, 2012
DOI:
10.3760/cma.j.issn.1674-1935.2012.05.004
Key Word:
Pancreatitis, acute necrotizing; Drainage; Percutaneous catheter drainage; Endoscopic drainage ; Opertation

Abstract: Objective To observe the clinical effectiveness of percutaneous catheter drainage ( PCD ) and PCD + negative pressure irrigation ( PCD + NPI ) for treatment of severe acute pancreatitis ( SAP ) patients with infective pancreatic necrosis (IPN).Methods Data of 71 IPN patients admitted from January 2010 to December 2011 were included and retrospectively analyzed.They were divided into two groups by the different treatment choices:PCD group (52 patients) and PCD + NPI group (19 patients).In PCD group,percutaneous pig-tail drainage catheter was inserted for intermittent IPN drainage,and in PCD + NPI group,negative pressure irrigation catheter was inserted for continuous IPN drainage.The indication for laparotomy surgery was no improvement after PCD or PCD + NPI for 3 days,or septic shock,abdominal cavity bleeding,digestive tract fistula occurred,the area of IPN decreased less than 1/2.Results The surgery rate of PCD +NPI group was 15.8%,which were significantly lower than that in PCD group (48.1%,P <0.05).7(36.8% ) patients in PCD + NPI group received endoscopic drainage,which were significantly higher than that in PCD (0,P <0.05).The time interval between initial tube placement and operation in the PCD + NPI group was (22 ± 11 ) d,which were significantly longer than that in PCD group [ ( 10 ± 6 ) d,P < 0.05 ].The difference of mean session and number of tube placement,number of laparotomy surgery,complications of laparotomy surgery in the two groups was not statistically significant.The mortality rate in the PCD + NPI group was 15.8%,which was not significantly higher than that in PCD group ( 13.5% ).The ICU days,length of hospital stay and hospital costs in PCD + NPI group were lower than those in the PCD group,but the difference between the two groups was not statistically significant.Conclusions PCD + NPI can effectively reduce operation rate for patients with infective pancreatic necrosis.

  • [1]Rau B,Bothe A,Beger HG.Surgical treatment of necrotizing pancreatitis by necrosectomy and closed lavage:changing patient characteristics and outcome in a 19 year,single-center series.Surgery,2005,138:28-39.
  • [2]Besselink MG,Van Santvoort HC,Schaapherder AF,et al.Feasibility of minimally invasive approaches in patients with infected necrotizing pancreatitis.Br J Surg,2007,94:604-608.
  • [3]Loveday BP,Rossaak JI,Mittal A,et al.Survey of trends in minimally invasive intervention for necrotizing pancreatitis.ANZ J Surg,2011,81:56-64.
  • [4]Haghshenasskashani A,Laurence JM,Kwan V,et al.Endoscopic necrosectomy of pancreatic necrosis:a systematic review.Surg Endosc,2011,25:3724-3730.
  • [5]Bruennler T,Langgartner J,Lang S,et al.Percutaneous necrosectomy in patients with acute,necrotizing pancreatitis.Eur Radiol,2008,18:1604-1610.
  • [6]黎介寿.腹部损伤控制性手术.中国实用外科杂志,2006,26:561-562.
  • [7]童智慧,李维勤,虞文魁,等.经皮穿刺置管引流与直接开腹手术引流治疗胰腺坏死组织感染的临床效果比较.中华外科杂志,2010,48:1387-1391.
  • [8]中华医学会外科学分会胰腺外科学组,重症急性胰腺炎诊治原则草案.中华外科杂志,2001,39:963-964.
  • [9]Banks PA,Freeman ML.Practice guidelines in acute pancreatiis.Am J Gastroenterol,2006,101:2379-2400.
  • [10]Rodriguez JR,Razo AO,Targarona J,et al.Debridement and closed packing for sterile or infected necrotizing pancreatitis:insights into indications and outcomes in 167 patients.Ann Surg,2008,247:294-299.
  • [11]Connor S,Alexakis N,Raraty MG,et al.Early and late complications after pancreatic necrosectomy.Surgery,2005,137:499-505.
  • [12]Freeny PC,Hauptmann E,Althaus S J,et al.Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis:techniques and results.Am J Roentgenol,1998,170:969-975.
  • [13]Charnley RM,Lochan R,Gray H,et al.Endoscopic necrosectomy as primary therapy in the management of infected pancreatic necrosis.Endoscopy,2006,38:925-928.
  • [14]Parekh D.Laparoscopic-assisted pancreatic necrosectomy:a new surgical option for treatment of severe necrotizing pancreatitis.Arch Surg,2006,141:895-902.
  • [15]Tong Z,Li W,Yu W,et al.Percutaneous catheter drainage for infective pancreatic necrosis:is it always the first choice for all patients? Pancreas,2012,41:302-305.
  • [16]黎介寿,任建安,尹路,等.肠外瘘的治疗.中华外科杂志,2002,40:100-103.
  • [17]李维勤,童智慧,全竹富,等.1033例重症急性胰腺炎治疗经验总结.中华外科杂志,2009,47:1472-1474.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615 Email:yiyao@wanfangdata.com.cn