Department of General and Emergency Surgery, Riga East Clinical University Hospital Gailezers, Riga, Latvia.
HPB (Oxford). 2013 Jul;15(7):535-40. doi: 10.1111/hpb.12004. Epub 2012 Nov 22.
The control of sepsis is the primary goal of surgical intervention in patients with infected necrosis. Simple surgical approaches that are easy to reproduce may improve outcomes when specialists in endoscopy are not available. The aim of the present study was to describe the experience with a focused open necrosectomy (FON) in patients with infected necrosis.
A prospective pilot study conducted to compare a semi-open/closed drainage laparotomy and FON with the assistance of peri-operative ultrasound. The incidence of sepsis, dynamics of C-reactive protein (CRP), intensive care unit (ICU)/hospital stay, complication rate and mortality were compared and analysed.
From a total of 58 patients, 36 patients underwent a conventional open necrosectomy and 22 patients underwent FON. The latter method resulted in a faster resolution of sepsis and a significant decrease in mean CRP on Day 3 after FON, P = 0.001. Post-operative bleeding was in 1 versus 7 patients and the incidence of intestinal and pancreatic fistula was 2 versus 8 patients when comparing FON to the conventional approach. The median ICU stay was 11.6 versus 23 days and the hospital stay was significantly shorter, 57 versus 72 days, P = 0.024 when comparing FON versus the conventional group. One patient died in the FON group and seven patients died in the laparotomy group, P = 0.139.
FON can be an alternative method to conventional open necrosectomy in patients with infected necrosis and unresolved sepsis.
在感染性坏死患者中，外科干预的首要目标是控制脓毒症。当没有内镜专家时，简单且易于复制的手术方法可能会改善治疗效果。本研究旨在描述一种聚焦性开放性坏死组织清除术（FON）在感染性坏死患者中的应用经验。
本前瞻性试点研究旨在比较半开放式/闭合式剖腹引流术与 FON 治疗方法，两种方法均在围手术期超声的辅助下进行。比较并分析了脓毒症的发生率、C 反应蛋白（CRP）的动态变化、重症监护病房（ICU）/住院时间、并发症发生率和死亡率。
共纳入 58 例患者，其中 36 例行传统开放性坏死组织清除术，22 例行 FON。后者方法可更快地控制脓毒症，且 FON 术后第 3 天 CRP 均值显著下降，P = 0.001。术后出血分别发生在 1 例和 7 例患者中，肠瘘和胰瘘的发生率分别为 2 例和 8 例，与传统方法相比，FON 组的发生率较低。与传统组相比，FON 组 ICU 住院时间中位数为 11.6 天，住院时间显著缩短，为 57 天，P = 0.024。FON 组有 1 例患者死亡，剖腹引流组有 7 例患者死亡，P = 0.139。
对于感染性坏死和未解决的脓毒症患者，FON 可作为传统开放性坏死组织清除术的替代方法。
