Kostka R, Havlůj J
Rozhl Chir. 2015 Apr;94(4):160-5.
Treatment of necrotizing pancreatitis continues to evolve. The standard therapeutic method for infected pancreatic necrosis and its subsequent septic complications is open surgical drainage. The advances in radiological imaging and interventional radiology have enabled the development of minimally invasive procedures, i.e. percutaneous drainage (PCD) under CT/USG control, endoscopic transgastric necrosectomy (ENE), laparoscopic transperitoneal necrosectomy (LNE) and retroperitoneal access to pancreatic necrosis (RENE).
Patients with acute pancreatitis treated from 2002 to 2013 (n=932) were included in the study. In patients with a severe form of the disease, results obtained in two groups of patients were compared: the first group was treated by classic laparotomy (group A), the second one was treated by means of minimally invasive procedures (group B). Statistical analysis employed the chi-square test.
During the mentioned period, 677 (72.6%) patients with a mild form and 255 (27.4%) with a severe form of the disease were treated. The male/female ratio was 1.4:1. In the group of patients suffering from a severe form of acute pancreatitis, 171 patients were treated conservatively, mortality rate being at 16.4% (28/171). Surgery was indicated in a total of 84 patients, mortality rate reaching 26.2% (22/84). Fifty-two of the patients underwent laparotomy (group A), minimally invasive procedures were used in a total of 32 patients (group B). Overall mortality in group A was 30.8% (16/52) vs. 18.8% (6/32) in group B, p = 0.224. The average length of hospitalization was longer in group A (65.4 days; median 52.4 vs. 49 days; median 36.5 in group B). PCD was the most frequent procedure performed in 19 patients; 5 of them died due to ongoing sepsis and multiorgan failure and 2 of them underwent revisional laparotomy. RENE was performed in 8 patients; lumbotomy was used in 5 of them. ENE was performed on 2 patients, 1 of them died, and LNE was used once. A less invasive procedure, the linea alba fasciotomy, was performed in 2 patients with intra-abdominal hypertension.
Open surgical drainage represents the standard treatment for infected pancreatic necrosis. Minimally invasive procedures are suitable alternatives especially in critically ill patients providing lower morbidity and mortality rates.
坏死性胰腺炎的治疗方法不断发展。感染性胰腺坏死及其继发的脓毒症并发症的标准治疗方法是开放手术引流。放射影像学和介入放射学的进展使得微创治疗方法得以发展，即CT/超声引导下的经皮引流（PCD）、内镜经胃坏死组织清除术（ENE）、腹腔镜经腹坏死组织清除术（LNE）以及经腹膜后途径清除胰腺坏死组织（RENE）。
纳入2002年至2013年期间接受治疗的急性胰腺炎患者（n = 932）。对于病情严重的患者，比较两组患者的治疗结果：第一组采用经典剖腹手术治疗（A组），第二组采用微创治疗方法（B组）。采用卡方检验进行统计分析。
在上述期间，治疗了677例（72.6%）轻症患者和255例（27.4%）重症患者。男女比例为1.4:1。在重症急性胰腺炎患者组中，171例患者接受保守治疗，死亡率为16.4%（28/171）。共有84例患者接受手术治疗，死亡率达26.2%（22/84）。52例患者接受了剖腹手术（A组），32例患者总共采用了微创治疗方法（B组）。A组的总体死亡率为30.8%（16/52），而B组为18.8%（6/32），p = 0.224。A组的平均住院时间更长（65.4天；中位数52.4天，而B组为49天；中位数36.5天）。PCD是最常实施的治疗方法，有19例患者接受该治疗；其中5例因持续脓毒症和多器官功能衰竭死亡，2例接受了再次剖腹手术。8例患者接受了RENE治疗；其中5例采用了腰部切开术。2例患者接受了ENE治疗，其中1例死亡，LNE治疗使用了1次。2例腹腔高压患者采用了侵入性较小的白线筋膜切开术。
开放手术引流是感染性胰腺坏死的标准治疗方法。微创治疗方法是合适的替代方案，特别是对于危重症患者，可降低发病率和死亡率。
