Mannan Fatima, Gill Roger Christopher, Sohail Abdul Ahad, Alvi Rehman, Ahmad Khabir
Aga Khan University Hospital, Pakistan.
Ann Med Surg (Lond). 2021 Feb 18;63:102159. doi: 10.1016/j.amsu.2021.02.005. eCollection 2021 Mar.
The main purpose of this study was to review the trends in management of patients presenting with acute necrotizing pancreatitis (ANP) over the last seven years and its effect on morbidity and mortality.
A cross-sectional study was conducted on all patients presenting with the diagnosis of acute necrotizing pancreatitis to the Aga Khan University Hospital in between the year 2008-2015. The study population was broadly categorized in to two groups based on the way these were managed. The first group consisted of patient who underwent surgery for acute necrotizing pancreatitis while the second group was composed of those patients with necrotizing pancreatitis who were conservatively managed. Patient outcomes were assessed in terms of hospital stay, complication rates and in-hospital mortality. Data was analyzed using SPSS version 20. Comparison of outcomes between two groups was done using chi-square test, Fischer exact test or -test wherever applicable. A p-value of less than 0.05 was considered statistically significant.
A total of n = 110 patients were included in the study with 68% (n = 75) males and 32% (n = 35) females. Nasojejunal route was found to be the most commonly utilized route of feeding in these patients consisting of around 49% (n = 54) patients with forty percent (n = 44) tolerating direct oral diet. The outcomes in both these groups in terms of hospital stay, complication rate, and in hospital mortality were not found to be statistically significant. The conservative group however was significant in terms of cost-effectiveness which was shown by a p value of (0.035). The management of this clinically important disease over the years showed an increased trend towards conservative approach in our institute.
Our study further substantiates the recent global trend of conservative approach towards managing patients with acute necrotizing pancreatitis as reflected in the recent available literature. Therefore surgeons of the developing world need to evolve and adapt to these new measures for better outcomes in patient management.
本研究的主要目的是回顾过去七年中急性坏死性胰腺炎（ANP）患者的治疗趋势及其对发病率和死亡率的影响。
对2008年至2015年间在阿迦汗大学医院被诊断为急性坏死性胰腺炎的所有患者进行了一项横断面研究。根据患者的治疗方式，研究人群大致分为两组。第一组由接受急性坏死性胰腺炎手术的患者组成，第二组由接受保守治疗的坏死性胰腺炎患者组成。根据住院时间、并发症发生率和院内死亡率评估患者的预后。使用SPSS 20版进行数据分析。两组之间的结果比较在适用的情况下使用卡方检验、费舍尔精确检验或t检验。p值小于0.05被认为具有统计学意义。
共有n = 110名患者纳入研究，其中男性占68%（n = 75），女性占32%（n = 35）。鼻空肠途径是这些患者最常用的喂养途径，约49%（n = 54）的患者采用该途径，40%（n = 44）的患者能够耐受直接口服饮食。在住院时间、并发症发生率和院内死亡率方面，这两组患者的结果均无统计学意义。然而，保守治疗组在成本效益方面具有显著性，p值为（0.035）。多年来，我院对这种临床重要疾病的治疗显示出越来越倾向于保守治疗的趋势。
我们的研究进一步证实了近期文献中反映的全球对急性坏死性胰腺炎患者采取保守治疗的趋势。因此，发展中国家的外科医生需要不断发展并适应这些新措施，以在患者管理中取得更好的效果。
