Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, 2-8-29, Musashidai, Fuchu City, Tokyo, Japan.
J Gastrointest Surg. 2020 Sep;24(9):2037-2045. doi: 10.1007/s11605-019-04333-7. Epub 2019 Aug 19.
Infected acute necrotic collections (ANC) and walled-off necrosis (WON) of the pancreas are associated with high mortality. The difference in mortality between open necrosectomy and minimally invasive therapies in these patients remains unclear.
This retrospective multicenter cohort study was conducted among 44 institutions in Japan from 2009 to 2013. Patients who had undergone invasive treatment for suspected infected ANC/WON were enrolled and classified into open necrosectomy and minimally invasive treatment (laparoscopic, percutaneous, and endoscopic) groups. The association of each treatment with mortality was evaluated and compared.
Of 1159 patients with severe acute pancreatitis, 122 with suspected infected ANC or WON underwent the following treatments: open necrosectomy (33) and minimally invasive treatment (89), (laparoscopic three, percutaneous 49, endoscopic 37). Although the open necrosectomy group had a significantly higher mortality on univariate analysis (p = 0.047), multivariate analysis showed no significant associations between open necrosectomy or Charlson index and mortality (p = 0.29, p = 0.19, respectively). However, age (for each additional 10 years, p = 0.012, odds ratio [OR] 1.50, 95% confidence interval [CI] 1.09-2.06) and revised Atlanta criteria-severe (p = 0.001, OR 7.84, 95% CI 2.40-25.6) were significantly associated with mortality.
In patients with acute pancreatitis and infected ANC/WON, age and revised Atlanta criteria-severe classification are significantly associated with mortality whereas open necrosectomy is not. The mortality risk for patients undergoing open necrosectomy and minimally invasive treatment does not differ significantly. Although minimally invasive surgery is generally preferred for patients with infected ANC/WON, open necrosectomy may be considered if clinically indicated.
感染性急性坏死性积聚（ANC）和胰腺包裹性坏死（WON）与高死亡率相关。在这些患者中，开放坏死清除术与微创治疗之间的死亡率差异尚不清楚。
本回顾性多中心队列研究于 2009 年至 2013 年在日本的 44 家机构中进行。纳入接受疑似感染性 ANC/WON 侵袭性治疗的患者，并将其分为开放坏死清除术和微创治疗（腹腔镜、经皮和内镜）组。评估并比较每种治疗方法与死亡率的相关性。
在 1159 例重症急性胰腺炎患者中，122 例疑似感染性 ANC 或 WON 患者接受了以下治疗：开放坏死清除术（33 例）和微创治疗（89 例）（腹腔镜 3 例、经皮 49 例、内镜 37 例）。虽然单因素分析显示开放坏死清除术组死亡率显著升高（p=0.047），但多因素分析显示开放坏死清除术或 Charlson 指数与死亡率之间无显著相关性（p=0.29，p=0.19）。然而，年龄（每增加 10 岁，p=0.012，优势比[OR]1.50，95%置信区间[CI]1.09-2.06）和修订亚特兰大标准-严重（p=0.001，OR 7.84，95% CI 2.40-25.6）与死亡率显著相关。
在患有急性胰腺炎和感染性 ANC/WON 的患者中，年龄和修订亚特兰大标准严重程度与死亡率显著相关，而开放坏死清除术则不然。接受开放坏死清除术和微创治疗的患者的死亡风险无显著差异。虽然微创外科通常适用于感染性 ANC/WON 患者，但如果临床需要，也可以考虑开放坏死清除术。
