Ulagendra Perumal Srinivasan, Pillai Sastha Ahanatha, Perumal Senthilkumar, Sathyanesan Jeswanth, Palaniappan Ravichandran
Institute of Surgical Gastroenterology and Liver Transplantation, Government Stanley Medical College, Chennai, India.
ANZ J Surg. 2014 Apr;84(4):270-4. doi: 10.1111/ans.12107. Epub 2013 Mar 4.
Surgery for necrotizing pancreatitis is associated with a high rate of morbidity and mortality. We present a series of 26 patients who underwent video-assisted translumbar retroperitoneal necrosectomy and analyse their outcomes.
Records of 26 patients who underwent video-assisted translumbar retroperitoneal necrosectomy and closed drainage for infected pancreatitic necrosis between January 2008 and March 2012 were reviewed, retrospectively.
Twenty-three out of 26 patients were males, with a mean age of 38.6 (±9.9) years. Alcohol was the aetiology in 18 patients, gall stones in 7, and in 1 it was idiopathic. The mean duration of symptoms before patients were taken up for surgery was 47.2 (±34.8) days. The mean computed tomography severity index was 7.7 (±1.2). All patients had undergone video-assisted retroperitoneal necrosectomy through a limited left lumbar incision. Post-operative lavage was given through drains placed in the retroperitoneum. Three patients required re-exploration. Eleven patients developed complications and there were two mortalities. The median intensive care unit (ICU) stay was 4 days (range 2-14 days). The mean post-operative hospital stay was 22.5 (±6.6) days.
Video-assisted translumbar retroperitoneal necrosectomy followed by closed lavage of infected pancreatic necrosis in select cases of infected pancreatic necrosis was associated with a low rate of ICU stay, hospital stay and need for re-entry.
坏死性胰腺炎手术的发病率和死亡率较高。我们报告了一系列26例行电视辅助经腰腹膜后坏死组织清除术的患者，并分析其治疗结果。
回顾性分析2008年1月至2012年3月期间26例行电视辅助经腰腹膜后坏死组织清除术及闭式引流治疗感染性胰腺坏死患者的病历资料。
26例患者中23例为男性，平均年龄38.6（±9.9）岁。病因是酒精性的有18例，胆石症7例，1例为特发性。患者接受手术前症状的平均持续时间为47.2（±34.8）天。平均计算机断层扫描严重指数为7.7（±1.2）。所有患者均通过有限的左腰部切口行电视辅助腹膜后坏死组织清除术。术后通过置于腹膜后的引流管进行灌洗。3例患者需要再次手术探查。11例患者出现并发症，2例死亡。重症监护病房（ICU）住院时间中位数为4天（范围2 - 14天）。术后平均住院时间为22.5（±6.6）天。
在部分感染性胰腺坏死病例中，采用电视辅助经腰腹膜后坏死组织清除术并对感染性胰腺坏死进行闭式灌洗，与较低的ICU住院率、住院时间及再次手术需求相关。
