Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB diseases, Stanley Medical College Hospital, Chennai, India.
Int J Surg. 2012;10(10):587-92. doi: 10.1016/j.ijsu.2012.09.027. Epub 2012 Sep 27.
Minimally invasive necrosectomy through a retroperitoneal approach has shown promising results for the treatment of necrotizing pancreatitis. There is however, little evidence from comparative studies in favor of these techniques over laparotomy.
To perform a case matched comparison of patients with necrotizing pancreatitis who underwent necrosectomy by the retroperitoneal approach with transperitoneal approach, thus minimizing the risk of confounding and selection bias.
Between August 2008 and March 2011, 85 patients were admitted with pancreatic necrosis. Each of the 15 patients who underwent necrosectomy by retroperitoneal approach using a small flank incision (RP group) were compared with 15 of those treated with necrosectomy by transperitoneal approach (TP group). These patients were matched for the age (±10 years), status of infection, CT severity score (±2 points), preoperative organ failure and timing for surgery (±7 days).
Postoperative complications occurred in 4 patients (26.6%) in the RP group and 8 (53.3%) in the TP group (p = 0.248). Reintervention, was required in 4 patients (26.6%) in the RP group and 7 (46.6%) in the TP group (p = 0.366). The median post operative ICU stay was 10 days in the RP group compared to 15 days in the TP group (p = 0.317). Median post operative hospital stay was 26 days in the RP group and 32 days in the TP group (p = 0.431). The total hospital stay among the survivors was 31 days in the RP group and 40 days in the TP group (p = 0.285).
The RP approach for pancreatic necrosectomy through a small flank incision was associated with less post operative morbidity compared to TP approach. The surgical outcomes in terms of post operative new onset organ failure and in hospital mortality were similar in both the groups, but the post op ICU/hospital stay and the total hospital stay was lower in the RP approach group. These results still requires to be confirmed by further randomized studies.
经腹膜后入路微创坏死组织清除术治疗坏死性胰腺炎已显示出良好的效果。然而，与剖腹手术相比，这些技术的比较研究证据很少。
通过对经腹膜后入路与经腹膜入路行坏死组织清除术的坏死性胰腺炎患者进行病例匹配比较，从而最大程度地减少混杂和选择偏倚的风险。
2008 年 8 月至 2011 年 3 月，85 例患者因胰腺坏死而入院。经腹膜后小侧入路行坏死组织清除术的 15 例患者（RP 组）与经腹膜入路行坏死组织清除术的 15 例患者（TP 组）进行比较。这些患者的年龄（±10 岁）、感染状态、CT 严重程度评分（±2 分）、术前器官衰竭和手术时机（±7 天）相匹配。
RP 组术后并发症 4 例（26.6%），TP 组 8 例（53.3%）（p=0.248）。RP 组需再次介入治疗 4 例（26.6%），TP 组 7 例（46.6%）（p=0.366）。RP 组术后 ICU 住院时间中位数为 10 天，TP 组为 15 天（p=0.317）。RP 组术后住院时间中位数为 26 天，TP 组为 32 天（p=0.431）。RP 组幸存者的总住院时间为 31 天，TP 组为 40 天（p=0.285）。
经腹膜后小侧入路行胰腺坏死组织清除术与经腹膜入路相比，术后并发症发生率较低。两组患者术后新发器官衰竭和住院死亡率的手术结果相似，但 RP 组术后 ICU/住院时间和总住院时间较低。这些结果仍需进一步的随机研究证实。
