Gomatos Ilias P, Halloran Christopher M, Ghaneh Paula, Raraty Michael G T, Polydoros Fotis, Evans Jonathan C, Smart Howard L, Yagati-Satchidanand R, Garry Jo M, Whelan Philip A, Hughes Faye E, Sutton Robert, Neoptolemos John P
*Clinical Directorate of General Surgery, National Institutes of Health Research Liverpool Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK †Liverpool Clinical Trials Unit, University of Liverpool, Liverpool, UK ‡Clinical Directorate of Radiology, National Institutes of Health Research Liverpool Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK §Clinical Directorate of Gastroenterology, National Institutes of Health Research Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital NHS Trust, Liverpool, UK.
Ann Surg. 2016 May;263(5):992-1001. doi: 10.1097/SLA.0000000000001407.
To examine the outcomes from minimal access retroperitoneal pancreatic necrosectomy (MARPN) and open pancreatic necrosectomy (OPN) for severe necrotizing pancreatitis in a single center.
The optimal management of severe pancreatic necrosis is evolving with a few large center single series.
Between 1997 and 2013, patients with necrotizing pancreatitis at the Liverpool Pancreas Center were reviewed. Outcome measures were retrospectively analyzed by intention to treat.
There were 394 patients who had either MARPN (274, 69.5%) or OPN (120, 30.5%). Complications occurred in 174 MARPN patients (63.5%) and 98 (81.7%) OPN patients (P < 0.001). OPN was associated with increased postoperative multiorgan failure [42 (35%) vs 56 (20.4%), P = 0.001] and median (inter-quartile range) Acute Physiology and Chronic Health Evaluation II score 9 (6-11.5) vs 8 (5-11), P < 0.001] with intensive care required less frequently in MARPN patients [40.9% (112) vs 75% (90), P < 0.001]. The mortality rate was 42 (15.3%) in MARPNs and 28 (23.3%) in OPNs (P = 0.064). Both the mortality and the overall complication rates decreased between 1997-2008 and 2008-2013 [49 (23.8%) vs 21 (11.2%) P = 0.001, respectively; and 151 (73.3%) vs 121 (64.4%), P = 0.080, respectively). Increased mortality was independently associated with age (P < 0.001), preoperative intensive care stay (P = 0.014), and multiple organ failure (P < 0.001); operation before 2008 (P < 0.001) and conversion to OPN (P = 0.035). MARPN independently reduced mortality odds risk (odds ratio = 0.27; 95% confidence interval = 0.12-0.57; P < 0.001).
Increasing experience and advances in perioperative care have led to improvement in outcomes. The role of MARPN in reducing complications and deaths within a multimodality approach remains substantial and should be used initially if feasible.
在单一中心研究微创腹膜后胰腺坏死清除术（MARPN）和开放性胰腺坏死清除术（OPN）治疗重症坏死性胰腺炎的疗效。
随着一些大型中心的单组系列研究，重症胰腺坏死的最佳治疗方法不断演变。
回顾1997年至2013年在利物浦胰腺中心接受治疗的坏死性胰腺炎患者。按意向性治疗对结局指标进行回顾性分析。
394例患者接受了MARPN（274例，69.5%）或OPN（120例，30.5%）。174例MARPN患者（63.5%）和98例OPN患者（81.7%）发生并发症（P<0.001）。OPN与术后多器官功能衰竭增加相关[42例（35%）对56例（20.4%），P=0.001]，急性生理与慢性健康状况评分II中位数（四分位间距）分别为9（6-11.5）和8（5-11），P<0.001]，MARPN患者需要重症监护的频率较低[40.9%（112例）对75%（90例），P<0.001]。MARPN组死亡率为42例（15.3%），OPN组为28例（23.3%）（P=0.064）。1997 - 2008年和2008 - 2013年期间，死亡率和总体并发症发生率均有所下降[分别为49例（23.8%）对21例（11.2%），P=0.001；151例（73.3%）对121例（6
