Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China,
Dig Surg. 2020;37(3):211-219. doi: 10.1159/000501076. Epub 2019 Jul 3.
Percutaneous or endoscopic drainage was usually performed as the first step in step-up approach for infected pancreatic necrosis (IPN). However, drainage was unnecessary or unavailable in some patients.
To estimate the safety and effect of one-step laparoscopic-assisted necrosectomy in IPN patients.
A retrospective analysis of IPN patients received surgical therapy in our center between January 2015 and December 2017 was performed. Patients were assigned to either one-step or step-up groups according to the received therapeutic approach. Incidence of complications, death, total number of interventions, and total hospital stay were compared. Logistic regression and nomogram were used to explore the risk factors and probability for patients undergoing interventions ≥3 times.
There were 45 and 49 patients included in one-step and step-up groups, respectively. No significant difference between groups in terms of new organ failure (14.29 vs. 14.33%, p = 0.832), death (8.89 vs.8.17%, p = 0.949), and long-term complications (18.37 vs. 15.56%, p = 0.717). However, the number of interventions in one-step group was significantly less than in step-up group with shorter hospital stay. After multivariate analysis, C-reactive protein, interleukin-6, and surgical approach were independent predicators for patients undergoing interventions ≥3. A nomogram was built with area under ROC curve 0.891.
Compared with step-up approach, one-step surgery was safe and effective in selected IPN patients with less interventions and shorter hospital stay.
经皮或内镜引流通常作为感染性胰腺坏死（IPN）升阶梯治疗的第一步。然而，在一些患者中，引流是不必要的或不可用的。
评估一步法腹腔镜辅助坏死组织清除术治疗 IPN 患者的安全性和效果。
回顾性分析了 2015 年 1 月至 2017 年 12 月在我院接受手术治疗的 IPN 患者。根据接受的治疗方法，将患者分为一步法组或升阶梯组。比较两组患者的并发症发生率、死亡率、总干预次数和总住院时间。采用 logistic 回归和列线图探讨患者行干预≥3 次的危险因素和概率。
一步法组和升阶梯组分别有 45 例和 49 例患者。两组患者新发器官衰竭（14.29% vs. 14.33%，p=0.832）、死亡率（8.89% vs. 8.17%，p=0.949）和长期并发症（18.37% vs. 15.56%，p=0.717）差异均无统计学意义。然而，一步法组的干预次数明显少于升阶梯组，且住院时间更短。多因素分析表明，C 反应蛋白、白细胞介素-6 和手术方式是患者行干预≥3 次的独立预测因子。构建了一个基于 ROC 曲线下面积为 0.891 的列线图。
与升阶梯方法相比，在选择合适的 IPN 患者中，一步法手术安全有效，干预次数更少，住院时间更短。
