Department of Gastroenterology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China (Ai XB, Pan WS, Wu LQ, Zhang WJ) Department of Gastroenterology, Zhuhai People's Hospital, Third Affiliated Hospital of Jinan University School of Medicine, Zhuhai 519000, China (Ai XB, Wang A); Department of Radiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China (Qian XP); Department of Ultrasonography, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China (Xu J).
World J Emerg Med. 2010;1(1):45-8.
Percutaneous catheter drainage (PCD) is a minimally invasive intervation for severe acute pancreatitis (SAP). This study was undertaken to compare the results of surgery and ultrasound-guided PCD in the treatment of 32 patients with SAP, and to direct clinicians to the most optimal approach for SAP.
In the 32 patients, 19 were proved to have deteriorated clinical signs or symptoms, extensive fluid exudation, and necrosis confirmed by computed tomography (CT) and they underwent operative debridement and drainage. For extensive fluid exudation or necrosis, complete liquefaction and safe catheter implantation, the other 13 patients were given PCD.
The mortality rate of the surgery group was 26.3%, much higher than that of the PCD group (0%). There was a significant difference between the two groups (P=0.044). The mean time for recovery of the serum C-reactive protein (CRP) level was 43.8 days in the surgery group, which was significantly longer than that of the PCD group (23.8 days) (P=0.034).
Early PCD guided by ultrasound could decrease the mortality of patients with severe acute pancreatitis, alleviate life-threatening inflammatory complications, and avoid unnecessary emergency operation.
经皮导管引流(PCD)是治疗重症急性胰腺炎(SAP)的一种微创介入方法。本研究旨在比较手术和超声引导下 PCD 在治疗 32 例 SAP 患者中的结果,为临床医生提供 SAP 最佳治疗方法的指导。
在这 32 例患者中,19 例患者的临床症状或体征恶化,广泛的液体渗出,CT 证实有坏死,行手术清创和引流。对于广泛的液体渗出或坏死,为了实现完全液化和安全的导管植入,另外 13 例患者接受了 PCD。
手术组的死亡率为 26.3%,明显高于 PCD 组(0%)(P=0.044)。两组之间有显著差异。手术组血清 C 反应蛋白(CRP)水平恢复正常的平均时间为 43.8 天,明显长于 PCD 组(23.8 天)(P=0.034)。
超声引导下早期进行 PCD 可降低重症急性胰腺炎患者的死亡率,减轻危及生命的炎症并发症,并避免不必要的急诊手术。