Aziret Mehmet, Ercan Metin, Toka Bilal, Parlak Erkan, Karaman Kerem
Department of General Surgery, Sakarya University Training and Research Hospital, Sakarya-Turkey.
Ulus Travma Acil Cerrahi Derg. 2018 Sep;24(5):488-496. doi: 10.5505/tjtes.2018.84589.
The aim of this study was to evaluate the risk factors for morbidity in cases of walled-off pancreatic necrosis (WOPN) and the performance of continuous postoperative lavage (CPL) for patients who demonstrated resistance to a minimally invasive approach.
The study enrolled 19 of 28 consecutive patients with WOPN who underwent surgical treatment or an endoscopic necrosectomy at Sakarya University Education and Research Hospital. The patients were divided into 2 groups according to the length of time from the first diagnosis of acute pancreatitis (AP) (Group 1, n=19) to preoperation or endoscopic necrosectomy (Group 2) (n=19). All of the cases were retrospectively evaluated and compared in terms of demographic features, operative features, and complications.
No statistically significant difference was found between the number of complications or the duration of hospital stay in terms of age, body mass index, size of the walled-off pancreatic necrosis, American Society of Anesthesiologists score, Ranson's criteria, operation time, and duration from AP to endoscopic necrosectomy or operation (p>0.05). Performance of an endoscopic necrosectomy was determined to be correlated with a decrease in the number of complications (B=-0.626, 95% confidence interval [CI]: -0.956 to -0.296; p<0.001), and when a high neutrophil-to-lymphocyte ratio (NLR) was detected at first admission, the number of complications was greater (B=0.032, 95% CI: 0.009-0.055; p=0.01). Reproduction in a culture and male gender were found to be risk factors for a prolonged hospital stay (B=0.669, 95% CI: 0.365-0.973; p<0.001), (B=0.484, 95% CI: 0.190-0.778; p=0.003), respectively.
CPL is a safe and effective surgical treatment approach for WOPN. Reproduction in a culture, male gender, and a high NLR on first admission and a negative or not-available endoscopic necrosectomy were determined to be risk factors for a poor prognosis.
本研究旨在评估壁式胰腺坏死（WOPN）病例发病的危险因素，以及对微创方法有抵抗的患者术后持续灌洗（CPL）的效果。
该研究纳入了在萨卡里亚大学教育与研究医院接受手术治疗或内镜坏死组织清除术的28例连续性WOPN患者中的19例。根据从首次诊断为急性胰腺炎（AP）（第1组，n = 19）到术前或内镜坏死组织清除术（第2组）（n = 19）的时间长度将患者分为两组。对所有病例的人口统计学特征、手术特征和并发症进行回顾性评估和比较。
在年龄、体重指数、壁式胰腺坏死大小、美国麻醉医师协会评分、兰森标准、手术时间以及从AP到内镜坏死组织清除术或手术的持续时间方面，并发症数量或住院时间均未发现有统计学意义的差异（p>0.05）。内镜坏死组织清除术的实施与并发症数量的减少相关（B = -0.626，95%置信区间[CI]：-0.956至-0.296；p<0.001），并且首次入院时检测到高中性粒细胞与淋巴细胞比率（NLR）时，并发症数量更多（B = 0.032，95%CI：0.009 - 0.055；p = 0.01）。培养物中细菌繁殖和男性被发现是住院时间延长的危险因素（B = 0.669，95%CI：0.365至0.973；p<0.001），（B = 0.484，95%CI：0.190至0.778；p = 0.003），
CPL是一种用于WOPN的安全有效的手术治疗方法。培养物中细菌繁殖、男性、首次入院时的高NLR以及阴性或无法进行的内镜坏死组织清除术被确定为预后不良的危险因素。
