From the Ten-Chan General Hospital Zhongli, Taoyuan.
Department of Surgery, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan.
Pancreas. 2021;50(10):1415-1421. doi: 10.1097/MPA.0000000000001949.
Acute pancreatitis can usually recover after conservative treatment. Five to 10 percent of acute pancreatitis may proceed into peripancreatic fluid collection and necrosis development, called necrotizing pancreatitis (NP), which has a high mortality rate. If it is accompanied by the occurrence of abdominal compartment syndrome (ACS) and does not respond to medical therapy, surgical intervention is indicated.
We analyzed our experience of surgical intervention strategies for NP patients with medically irreversible ACS from January 1, 2004, to December 31, 2018.
Of the 47 NP patients with ACS, mean Ranson score was 6.5, mean Acute Physiology and Chronic Health Evaluation II score was 22.2, and Modified computed tomography severity index score was all 8 or greater. The mean total postoperative hospital length of stay was 80.2 days, of which the mean intensive care unit length of stay was 16.6 days. The overall complication rate was 31.9%. The mortality rate was 8.5%. Among the 47 patients, only fungemia was significantly associated with mortality incidence.
The combination of multiple drainage tube placement, feeding jejunostomy, and ileostomy at the same time were effective surgical intervention strategies for NP patients with ACS, which brought a lower mortality rate.
急性胰腺炎经保守治疗后通常可痊愈。5%-10%的急性胰腺炎可能会发展为胰周液体积聚和坏死，即坏死性胰腺炎（NP），其死亡率较高。如果 NP 伴有腹腔间隔室综合征（ACS）且对药物治疗无反应，则需要进行手术干预。
我们分析了自 2004 年 1 月 1 日至 2018 年 12 月 31 日期间，因 ACS 经药物治疗无效而接受手术干预的 NP 患者的经验。
47 例 ACS 合并 NP 患者的平均 Ranson 评分 6.5 分，平均急性生理学和慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分 22.2 分，改良 CT 严重指数评分均≥8 分。术后总住院时间的平均值为 80.2 天，其中 ICU 住院时间的平均值为 16.6 天。总的并发症发生率为 31.9%。死亡率为 8.5%。在这 47 例患者中，仅真菌感染与死亡率的发生显著相关。
对于 ACS 合并 NP 患者，同时进行多个引流管放置、空肠造口术和回肠造口术是有效的手术干预策略，可降低死亡率。
