感染性胰腺坏死的延迟处理分析。
Analysis of the delayed approach to the management of infected pancreatic necrosis.
机构信息
Department of Gastrointestinal Surgery, Jaslok Hospital and Research Center, Mumbai 400026, India.
出版信息
World J Gastroenterol. 2011 Jan 21;17(3):366-71. doi: 10.3748/wjg.v17.i3.366.
AIM
To analyze outcomes of delayed single-stage necrosectomy after early conservative management of patients with infected pancreatic necrosis (IPN) associated with severe acute pancreatitis (SAP).
METHODS
Between January 1998 and December 2009, data from patients with SAP who developed IPN and were managed by pancreatic necrosectomy were analyzed.
RESULTS
Fifty-nine of 61 pancreatic necrosectomies were performed by open surgery and 2 laparoscopically. In 55 patients, single-stage necrosectomy could be performed (90.2%). Patients underwent surgery at a median of 29 d (range 13-46 d) after diagnosis of acute pancreatitis. Sepsis and multiple organ failure accounted for the 9.8% mortality rate. Pancreatic fistulae (50.8%) predominantly accounted for the morbidity. The median hospital stay was 23 d, and the median interval for return to regular activities was 110 d.
CONCLUSION
This series supports the concept of delayed single-stage open pancreatic necrosectomy for IPN. Advances in critical care, antibiotics and interventional radiology have played complementary role in improving the outcomes.
目的
分析在伴有重症急性胰腺炎（SAP）的感染性胰腺坏死（IPN）早期行保守治疗后延迟进行一期坏死组织清除术的结果。
方法
分析 1998 年 1 月至 2009 年 12 月间接受胰腺坏死组织清除术治疗的 SAP 合并 IPN 患者的数据。
结果
59 例胰腺坏死组织清除术采用开腹手术，2 例采用腹腔镜手术。55 例患者可进行一期坏死组织清除术（90.2%）。患者在诊断为急性胰腺炎后中位 29 天（范围 13-46 天）接受手术。败血症和多器官衰竭占死亡率的 9.8%。胰瘘（50.8%）是主要的并发症。中位住院时间为 23 天，恢复正常活动的中位间隔时间为 110 天。
结论
本系列研究支持对 IPN 行延迟一期开放性胰腺坏死组织清除术的理念。重症监护、抗生素和介入放射学的进步在改善结果方面发挥了互补作用。
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