Charnley R M, Lochan R, Gray H, O'Sullivan C B, Scott J, Oppong K E N W
Hepato-Pancreato-Biliary Unit, Freeman Hospital, Newcastle upon Tyne, UK.
Endoscopy. 2006 Sep;38(9):925-8. doi: 10.1055/s-2006-944731.
Open pancreatic necrosectomy is the standard treatment for infected pancreatic necrosis but is associated with significant morbidity, mortality, and prolonged hospital stay. Percutaneous or endoscopic necrosectomy are alternative techniques. We evaluated the use of endoscopic necrosectomy for treatment of patients with necrosis that could be accessed through the posterior wall of the stomach.
We retrospectively analyzed the indication, patient status according to acute physiology and chronic health evaluation (APACHE) 2 severity score, and success of endoscopic necrosectomy as primary treatment, in selected patients with localized infected pancreatic necrosis, who presented between May 2002 and October 2004. After the necrosis cavity had been accessed, with the assistance of endoscopic ultrasound, a large orifice was created and necrotic debris was removed using endoscopic accessories under radiological control. Follow-up was clinical and radiological.
13 patients (nine men, four women, mean age 53 years), 11 with positive bacteriology, underwent attempted endoscopic necrosectomy. Median APACHE 2 score on presentation was 8 (range 1-18). Four patients needed intensive therapy unit care and one other patient required (nonventilatory) high-dependency unit care only. Necrosis was successfully treated endoscopically in 12 patients, requiring a mean of 4 endoscopic interventions (range 1-10); one patient required open surgery; two underwent additional percutaneous necrosectomy and one required laparoscopic drainage. Two patients died of complications unrelated to the procedure. The 11 survivors have a median (range) follow-up of 16 (6-38) months.
Endoscopic necrosectomy is a safe method for treatment of infected pancreatic necrosis. Multiple procedures are usually needed. It may be combined with other methods of surgical intervention. Larger prospective studies will more precisely define its role.
开放性胰腺坏死清除术是治疗感染性胰腺坏死的标准方法，但该方法会导致较高的发病率、死亡率以及延长住院时间。经皮或内镜下坏死组织清除术是替代技术。我们评估了内镜下坏死组织清除术用于治疗可经胃后壁进入的坏死患者的疗效。
我们回顾性分析了2002年5月至2004年10月间选定的局部感染性胰腺坏死患者的内镜下坏死组织清除术作为主要治疗方法的适应证、根据急性生理与慢性健康状况评估（APACHE）Ⅱ严重程度评分的患者状况以及手术成功率。在通过内镜超声进入坏死腔后，创建一个大的开口，并在放射学控制下使用内镜附件清除坏死碎片。随访包括临床和影像学检查。
13例患者（9例男性，4例女性，平均年龄53岁），11例细菌学检查呈阳性，接受了内镜下坏死组织清除术尝试。就诊时APACHEⅡ评分中位数为8（范围1 - 18）。4例患者需要重症监护病房护理，另外1例患者仅需要（非通气）高依赖病房护理。12例患者的坏死通过内镜成功治疗，平均需要4次内镜干预（范围1 - 10）；1例患者需要接受开放手术；2例患者接受了额外的经皮坏死组织清除术，1例患者需要腹腔镜引流。2例患者死于与手术无关的并发症。11例幸存者的中位（范围）随访时间为16（6 - 38）个月。
内镜下坏死组织清除术是治疗感染性胰腺坏死的一种安全方法。通常需要多次手术。它可以与其他手术干预方法联合使用。更大规模的前瞻性研究将更精确地确定其作用。
