感染性胰腺坏死的逐步微创外科手术：前瞻性队列研究结果
Step-up mini-invasive surgery for infected pancreatic necrosis: Results from prospective cohort study.
作者信息
Li Ang, Cao Feng, Li Jia, Fang Yu, Wang Xiaohui, Liu Dian-Gang, Li Fei
机构信息
Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China.
Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, PR China.
出版信息
Pancreatology. 2016 Jul-Aug;16(4):508-14. doi: 10.1016/j.pan.2016.03.014. Epub 2016 Mar 31.
OBJECTIVES
To investigate the clinical efficacy and success predictors of mini-invasive techniques in the treatment of infected pancreatic necrosis (IPN).
METHODS
IPN patients admitted to our clinic for treatment by mini-invasive techniques were included in this study prospectively. Treatment was divided into four sequential phases: percutaneous catheter drainage (PCD), mini-incision drainage (MID), video assisted debridement (VAD) and open surgery. Patients progressed to next phase if the infection cannot be controlled. The frequency of surgery, treatment duration, cure rate, incidence of complication and overall mortality were recorded. Risk factors for failure of PCD and MID procedures were detected by logistic regression including demographics, disease severity and morphologic characteristics.
RESULTS
From January 2012 to March 2015, a total of 54 consecutive IPN patients were treated, with an average age of 51.2 ± 3.1 years. Of the 54 cases, 18 (33.3%) were cured after PCD; 13 (24.1%) with uncontrolled infection were cured after MID; and the remaining 19 cases (35.2%) were cured after VAD. No open surgery was performed. Overall mortality was 7.4% (4/54), and the incidence of complications was 12.9% (7/54). In multivariable regression, the following factors were associated with high failure rate for both PCD and MID: heterogeneous fluid collection (odds ratio (OR) = 3.14; 95% confidence interval (CI): 1.32 ～ 4.25, P = 0.001 for PCD; OR = 2.99; 95% CI: 1.52 ～ 5.10, P = 0.006 for MID), multiple infected collections (OR = 4.51; 95% CI: 2.94 ～ 8.63; P = 0.000 for PCD; OR = 4.17; 95% CI: 2.77 ～ 8.12, P = 0.000 for MID), CT severity index (0 ～ 3/4 ～ 6/7 ～ 10: OR = 2.16; 95% CI: 1.83 ～ 3.62, P = 0.031 for PCD; OR = 2.72; 95% CI: 1.78 ～ 4.10, P = 0.005 for MID).
CONCLUSIONS
Step-up mini-invasive techniques can be considered a first choice in the treatment of IPN. CT is effective to predict success of PCD and MID.
目的
探讨微创技术治疗感染性胰腺坏死（IPN）的临床疗效及成功预测因素。
方法
前瞻性纳入在我院接受微创技术治疗的IPN患者。治疗分为四个连续阶段：经皮导管引流（PCD）、小切口引流（MID）、视频辅助清创（VAD）和开放手术。若感染无法控制，患者进入下一阶段。记录手术频率、治疗持续时间、治愈率、并发症发生率和总死亡率。通过逻辑回归分析检测PCD和MID手术失败的危险因素，包括人口统计学、疾病严重程度和形态学特征。
结果
2012年1月至2015年3月，共连续治疗54例IPN患者，平均年龄51.2±3.1岁。54例患者中，18例（33.3%）经PCD治愈；13例（24.1%）感染未控制患者经MID治愈；其余19例（35.2%）经VAD治愈。未进行开放手术。总死亡率为7.4%（4/54），并发症发生率为12.9%（7/54）。多变量回归分析显示，以下因素与PCD和MID的高失败率相关：液体聚集不均一（比值比（OR）=3.14；95%置信区间（CI）：1.32～4.25，PCD的P=0.001；OR=2.99；95%CI：1.52～5.10，MID的P=0.006）、多个感染灶（OR=4.51；95%CI：2.94～8.63；PCD 的P=0.000；OR=4.17；95%CI：2.77～8.12，MID的P=0.000）、CT严重程度指数（0～3/4～6/7～10：PCD的OR=2.16；95%CI：1.83～3.62，P=0.031；MID的OR=2.72；95%CI：1.78～4.10，P=0.005）。
结论
逐步升级的微创技术可被视为IPN治疗的首选。CT对预测PCD和MID的成功有效。
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