Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
Gastroenterology. 2011 Oct;141(4):1254-63. doi: 10.1053/j.gastro.2011.06.073. Epub 2011 Jul 8.
BACKGROUND & AIMS: Treatment of patients with necrotizing pancreatitis has become more conservative and less invasive, but there are few data from prospective studies to support the efficacy of this change. We performed a prospective multicenter study of treatment outcomes among patients with necrotizing pancreatitis.
We collected data from 639 consecutive patients with necrotizing pancreatitis, from 2004 to 2008, treated at 21 Dutch hospitals. Data were analyzed for disease severity, interventions (radiologic, endoscopic, surgical), and outcome.
Overall mortality was 15% (n=93). Organ failure occurred in 240 patients (38%), with 35% mortality. Treatment was conservative in 397 patients (62%), with 7% mortality. An intervention was performed in 242 patients (38%), with 27% mortality; this included early emergency laparotomy in 32 patients (5%), with 78% mortality. Patients with longer times between admission and intervention had lower mortality: 0 to 14 days, 56%; 14 to 29 days, 26%; and >29 days, 15% (P<.001). A total of 208 patients (33%) received interventions for infected necrosis, with 19% mortality. Catheter drainage was most often performed as the first intervention (63% of cases), without additional necrosectomy in 35% of patients. Primary catheter drainage had fewer complications than primary necrosectomy (42% vs 64%, P=.003). Patients with pancreatic parenchymal necrosis (n=324), compared with patients with only peripancreatic necrosis (n=315), had a higher risk of organ failure (50% vs 24%, P<.001) and mortality (20% vs 9%, P<.001).
Approximately 62% of patients with necrotizing pancreatitis can be treated without an intervention and with low mortality. In patients with infected necrosis, delayed intervention and catheter drainage as first treatment improves outcome.
治疗坏死性胰腺炎的方法已变得更加保守和微创，但很少有前瞻性研究的数据支持这种变化的疗效。我们进行了一项针对坏死性胰腺炎患者治疗结果的前瞻性多中心研究。
我们收集了 2004 年至 2008 年期间，21 家荷兰医院收治的 639 例坏死性胰腺炎连续患者的数据。分析了疾病严重程度、干预措施（放射、内镜、手术）和结果。
总体死亡率为 15%（n=93）。240 例患者（38%）发生器官衰竭，死亡率为 35%。397 例患者（62%）接受了保守治疗，死亡率为 7%。242 例患者（38%）接受了干预治疗，死亡率为 27%；其中 32 例（5%）患者进行了早期紧急剖腹手术，死亡率为 78%。入院至干预之间的时间较长的患者死亡率较低：0 至 14 天，56%；14 至 29 天，26%；>29 天，15%（P<.001）。总共 208 例（33%）患者接受了感染性坏死的干预治疗，死亡率为 19%。导管引流是最常进行的首次干预（63%的病例），其中 35%的患者没有进行额外的坏死切除术。原发性导管引流的并发症少于原发性坏死切除术（42%比 64%，P=.003）。与仅患有胰周坏死的患者（n=315）相比，胰腺实质坏死的患者（n=324）发生器官衰竭（50%比 24%，P<.001）和死亡率（20%比 9%，P<.001）的风险更高。
大约 62%的坏死性胰腺炎患者可以不进行干预治疗，且死亡率较低。对于感染性坏死的患者，延迟干预和导管引流作为初始治疗可改善结果。
