Department of Surgery, The First Affiliated Hospital, Wenzhou Medical College, 2 Fuxue Lane, Wenzhou, Zhejiang Province, China.
Pancreatology. 2013 May-Jun;13(3):212-5. doi: 10.1016/j.pan.2013.02.004. Epub 2013 Feb 24.
Our aim was to investigate the efficiency of continuous regional intra-arterial infusion (CRAI) with antisecretory agents and antibiotics in the treatment of infected pancreatic necrosis.
CRAI was used as a new clinical technique to treat acute pancreatitis patients during a 4-year period at the First Affiliated Hospital, Wenzhou Medical College, China. In this retrospective study, thirty-four patients with proven infected pancreatic necrosis were included. Twelve patients were treated with CRAI, and were matched according to age, sex, APACHE II scores, Ranson scores and remote organ dysfunction, with 22 patients with IPN treated surgically. The clinical outcome following surgery and CRAI were compared.
No difference was found between the two groups when comparing age, gender, APACHE II scores, Ranson scores and remote organ dysfunction (p > 0.05). The patients treated with CRAI had a lower incidence of complications (33.3% vs 72.7%), duration of hospitalization (27.1 ± 4.7 days vs 43.0 ± 12.0 days) and cost of hospitalization (4.09 ± 1.64 thousand RMB vs 8.77 ± 3.74 thousand RMB) as compared to patients treated with surgery (p < 0.05). The survival rate was significantly higher in the CRAI group as compared to the surgical group (91.7% vs 63.6%; p < 0.01). However, the two groups had similar rates of concomitant operative treatment and incidence of remote organ dysfunction (p > 0.05).
CRAI or CRAI in combination with abscess drainage seemingly improve the clinical outcome in patients with infected pancreatic necrosis. Further confirmative prospective randomized multicenter studies are warranted prior to broad introduction of the CRAI concept.
本研究旨在探讨采用持续区域性动脉内输注（CRAI）联合抑酸和抗生素治疗感染性胰腺坏死的疗效。
回顾性分析温州医科大学附属第一医院近 4 年采用 CRAI 治疗的急性胰腺炎患者的临床资料。本研究共纳入 34 例经证实的感染性胰腺坏死患者，其中 12 例采用 CRAI 治疗（CRAI 组），并根据年龄、性别、急性生理和慢性健康评分（APACHE II）、Ranson 评分和远隔器官功能障碍情况，与同期 22 例行手术治疗的感染性胰腺坏死患者（手术组）进行匹配。比较两组患者的临床转归。
两组患者的年龄、性别、APACHE II 评分、Ranson 评分和远隔器官功能障碍差异均无统计学意义（P＞0.05）。与手术组相比，CRAI 组患者的并发症发生率较低（33.3% vs 72.7%），住院时间较短（27.1±4.7 d vs 43.0±12.0 d），住院费用较少（4.09±1.64 万人民币 vs 8.77±3.74 万人民币），差异均有统计学意义（P＜0.05）。CRAI 组的生存率显著高于手术组（91.7% vs 63.6%；P＜0.01）。但两组患者的联合手术治疗率和远隔器官功能障碍发生率差异均无统计学意义（P＞0.05）。
CRAI 或 CRAI 联合脓肿引流术可改善感染性胰腺坏死患者的临床转归。在广泛应用 CRAI 治疗前，尚需开展进一步的、前瞻性、随机、多中心研究。
