升阶梯策略治疗感染性坏死性胰腺炎：单中心 20 年经皮置管引流经验。

Step-up approach to infected necrotising pancreatitis: a 20-year experience of percutaneous drainage in a single centre.

机构信息

University Clinical Center, Tuzla, Bosnia and Herzegovina.

出版信息

Dig Liver Dis. 2011 Jun;43(6):478-83. doi: 10.1016/j.dld.2011.02.020. Epub 2011 Apr 8.

DOI:10.1016/j.dld.2011.02.020

PMID:21478061

Abstract

AIM

To evaluate the efficacy of step-up approach to infected necrotising pancreatitis.

METHODS

Retrospective analysis of 86 patients treated by step-up approach from 1989 to 2009. Infection was confirmed by examination of aspirated material or by presence of free pancreatic gas at contrast-enhanced computed tomography. Conservative treatment was initially attempted in all patients; percutaneous catheter drainage was performed when conservative therapy failed; surgery was planned only if no clinical improvement was observed. Primary outcome was mortality.

RESULTS

Fifteen patients (17.4%) were successfully treated with conservative treatment only. Percutaneous catheter drainage was performed in 69 (80.2%). Eight patients (9.3%) died, two at week 1 without drainage or surgery and six after percutaneous catheter drainage and surgery. Eleven patients were converted to surgery (12.8%). Organ failure occurred in 59/86 (68.6%) and multiorgan failure in 25/86 (29.1%). Median (interquartile ranges) hospital stay and catheter dwell times were 13 (9-47) and 15 (7-34) days, respectively. There were 2.61 catheter problems and 1.68 catheter changes per patient.

CONCLUSIONS

The step-up approach is an effective and safe strategy for the treatment of infected necrotising pancreatitis. Percutaneous drainage can avert the need for surgery in the majority of patients.

摘要

目的

评估升阶梯方法治疗感染性坏死性胰腺炎的疗效。

方法

回顾性分析 1989 年至 2009 年采用升阶梯方法治疗的 86 例患者。通过抽吸物检查或增强 CT 检查显示有游离胰腺气体来确认感染。所有患者均首先尝试保守治疗；如果保守治疗失败，则进行经皮导管引流；如果没有临床改善，则计划手术。主要结局为死亡率。

结果

15 例（17.4%）患者仅通过保守治疗成功治愈。69 例（80.2%）患者进行了经皮导管引流。8 例（9.3%）患者死亡，其中 2 例在没有引流或手术的情况下于第 1 周死亡，6 例在经皮导管引流和手术后死亡。11 例患者转为手术治疗（12.8%）。86 例患者中有 59 例（68.6%）发生器官衰竭，25 例（29.1%）发生多器官衰竭。中位（四分位间距）住院时间和导管留置时间分别为 13（9-47）天和 15（7-34）天。每位患者有 2.61 次导管问题和 1.68 次导管更换。