Unit of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, Autonomous University of Barcelona, Hospital del Mar, Barcelona, Spain.
Department of Gastroenterology, Hospital del Mar, Barcelona, Spain.
Int J Surg. 2018 Mar;51:164-169. doi: 10.1016/j.ijsu.2018.01.017. Epub 2018 Feb 1.
To assess the minimally invasive surgery into the step-up approach procedures as a standard treatment for severe acute pancreatitis and comparing its results with those obtained by classical management.
Retrospective cohort study comparative with two groups treated over two consecutive, equal periods of time were defined: group A, classic management with open necrosectomy from January 2006 to June 2010; and group B, management with the step-up approach with minimally invasive surgery from July 2010 to December 2014.
In group A, 83 patients with severe acute pancreatitis were treated, of whom 19 underwent at least one laparotomy, and in 5 any minimally invasive surgery. In group B, 81 patients were treated: minimally invasive surgery was necessary in 17 cases and laparotomy in 3. Among operated patients, the time from admission to first interventional procedures was significantly longer in group B (9 days vs. 18.5 days; p = 0.042). There were no significant differences in Intensive Care Unit stay or overall stay: 9.5 and 27 days (group A) vs. 8.5 and 21 days (group B). Mortality in operated patients and mortality overall were 50% and 18.1% in group A vs 0% and 6.2% in group B (p < 0.001 and p = 0.030).
The combination of the step-up approach and minimally invasive surgery algorithm is feasible and could be considered as the standard of treatment for severe acute pancreatitis. The mortality rate deliberately descends when it is used.
评估微创外科逐步升级方法作为治疗重症急性胰腺炎的标准治疗方法，并将其结果与经典治疗方法进行比较。
回顾性队列研究比较了两个连续相等时间段内治疗的两组患者：A 组，2006 年 1 月至 2010 年 6 月采用开放式坏死组织切除术的经典治疗；B 组，2010 年 7 月至 2014 年 12 月采用微创外科逐步升级方法治疗。
A 组中，83 例重症急性胰腺炎患者接受了治疗，其中 19 例行至少一次剖腹手术，5 例行任何微创外科手术。B 组中，81 例患者接受了治疗：微创外科手术在 17 例中是必要的，剖腹手术在 3 例中是必要的。在接受手术的患者中，B 组从入院到首次介入治疗的时间明显更长（9 天与 18.5 天；p=0.042）。重症监护病房停留时间或总停留时间无显著差异：A 组为 9.5 和 27 天，B 组为 8.5 和 21 天。在接受手术的患者中，A 组的死亡率和总死亡率分别为 50%和 18.1%，B 组分别为 0%和 6.2%（p<0.001 和 p=0.030）。
逐步升级方法与微创外科算法相结合是可行的，可以考虑作为重症急性胰腺炎的治疗标准。当使用这种方法时，死亡率明显下降。
