Bruennler T, Langgartner J, Lang S, Wrede C E, Klebl F, Zierhut S, Siebig S, Mandraka F, Rockmann F, Salzberger B, Feuerbach S, Schoelmerich J, Hamer O W
Department of Internal Medicine I, University of Regensburg, Regensburg D-93042, Germany.
World J Gastroenterol. 2008 Feb 7;14(5):725-30. doi: 10.3748/wjg.14.725.
To assess the outcome of patients with acute necrotizing pancreatitis treated by percutaneous drainage with special focus on the influence of drainage size and number.
We performed a retrospective analysis of 80 patients with acute pancreatitis requiring percutaneous drainage therapy for infected necroses. Endpoints were mortality and length of hospital stay. The influence of drainage characteristics such as the median drainage size, the largest drainage size per patient and the total drainage plane per patient on patient outcome was evaluated.
Total hospital survival was 66%. Thirty-four patients out of all 80 patients (43%) survived acute necrotizing pancreatitis with percutaneous drainage therapy only. Eighteen patients out of all 80 patients needed additional percutaneous necrosectomy (23%). Ten out of these patients required surgical necrosectomy in addition, 6 patients received open necrosectomy without prior percutaneous necrosectomy. Elective surgery was performed in 3 patients receiving cholecystectomy and one patient receiving resection of the parathyroid gland. The number of drainages ranged from one to fourteen per patient. The drainage diameter ranged from 8 French catheters to 24 French catheters. The median drainage size as well as the largest drainage size used per patient and the total drainage area used per patient did not show statistically significant influence on mortality.
Percutaneous drainage therapy is an effective tool for treatment of necrotizing pancreatitis. Large bore drainages did not prove to be more effective in controlling the septic focus.
评估经皮引流治疗急性坏死性胰腺炎患者的疗效，特别关注引流管大小和数量的影响。
我们对80例因感染性坏死而需要经皮引流治疗的急性胰腺炎患者进行了回顾性分析。终点指标为死亡率和住院时间。评估了引流特征（如引流管中位大小、每位患者最大引流管大小和每位患者总引流平面）对患者预后的影响。
总住院生存率为66%。80例患者中有34例（43%）仅通过经皮引流治疗存活了急性坏死性胰腺炎。80例患者中有18例需要额外的经皮坏死组织清除术（23%）。其中10例患者还需要手术坏死组织清除术，6例患者在未进行经皮坏死组织清除术的情况下接受了开放性坏死组织清除术。3例接受胆囊切除术的患者和1例接受甲状旁腺切除术的患者进行了择期手术。每位患者的引流管数量为1至14根。引流管直径范围为8法式导管至24法式导管。引流管中位大小、每位患者使用的最大引流管大小和每位患者使用的总引流面积对死亡率均未显示出统计学上的显著影响。
经皮引流治疗是治疗坏死性胰腺炎的有效手段。大口径引流管在控制感染灶方面并未被证明更有效。
