Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88# Jiefang Road, 310009 Hangzhou, China.
J Gastroenterol. 2010;45(1):77-85. doi: 10.1007/s00535-009-0129-4. Epub 2009 Sep 29.
To evaluate the efficacy and safety of ultrasound-guided percutaneous catheter drainage (PCD) treatment for severe acute pancreatitis compared to conservative and conventional surgical treatments.
Eighty-one patients with severe acute pancreatitis (SAP) were admitted and divided into three groups: forty-nine cases in the conservative therapy group; nineteen cases in the surgery group; and thirteen cases in the PCD therapy group. Forty-five patients with a CT severity index (CTSI) < or = 8.0 received conservative treatment. One patient with CTSI = 7.0 underwent surgery. Thirty-five patients with a CTSI > 8.0 were randomly selected for surgery or PCD treatment. After randomization, six patients (four patients in the surgery group and two patients in the PCD group) were dropped from the study. The total number of patients included in the surgery and PCD groups was sixteen and thirteen, respectively.
Four patients (8.2%) in the conservative therapy group died, five patients (31.3%) in surgery group with a CTSI > 8.0 died, and all patients in the PCD group survived. The mortality rate was lower in the PCD group than in the surgery group (P = 0.048). The serum C-reactive protein (CRP) level recovered more quickly in patients in the PCD group compared to those in the surgery group (P < 0.001).
Patients with SAP and a CTSI < or = 8.0 could be treated with conservative therapy, while patients with a CTSI > 8.0 should be treated with surgery or PCD therapy if the life-threatening complications of extensive fluid collection or necrosis are a factor. However, PCD therapy used in a timely manner for drainage may decrease mortality in patients with SAP, decrease inflammatory mediator release, and avoid incidence of severe sepsis or acute respiratory distress syndrome (ARDS) and emergency surgery.
评估超声引导经皮穿刺导管引流（PCD）治疗与保守治疗和传统手术治疗相比治疗重症急性胰腺炎的疗效和安全性。
共 81 例重症急性胰腺炎（SAP）患者入院，分为三组：保守治疗组 49 例，手术组 19 例，PCD 治疗组 13 例。45 例 CT 严重指数（CTSI）<或=8.0 患者采用保守治疗，1 例 CTSI=7.0 患者手术治疗。35 例 CTSI>8.0 患者随机选择手术或 PCD 治疗。随机分组后，手术组有 4 例和 PCD 组有 2 例患者脱落。手术组和 PCD 组的患者总数分别为 16 例和 13 例。
保守治疗组有 4 例（8.2%）患者死亡，手术组中 CTSI>8.0 的 5 例患者死亡，PCD 组所有患者均存活。PCD 组死亡率低于手术组（P=0.048）。PCD 组患者血清 C 反应蛋白（CRP）水平恢复较快，与手术组相比差异有统计学意义（P<0.001）。
CTSI<或=8.0 的 SAP 患者可采用保守治疗，而 CTSI>8.0 的患者如果广泛积液或坏死的危及生命的并发症是一个因素，则应采用手术或 PCD 治疗。然而，及时进行引流的 PCD 治疗可能会降低 SAP 患者的死亡率，减少炎症介质的释放，避免严重脓毒症或急性呼吸窘迫综合征（ARDS）和急诊手术的发生。
