Dost Wahidullah, Qasemi Farzad, Ali Wahida, Aini Tahmina, Rasully Mohammad Qaher, Niazi Jamaluddin, Sarhadi Jamal Rana, Sayer Maseha, Qadar Laila Tul, Afzali Sultan Masoud Shah
General Surgery, Liaquatian Academic & Research Society, Hyderabad, PAK.
Cardiovascular Surgery, Punjab Institute of Cardiology, Lahore, PAK.
Cureus. 2022 Jul 1;14(7):e26485. doi: 10.7759/cureus.26485. eCollection 2022 Jul.
Immediate or delayed catheter drainage of infected pancreatic necrosis remains a subject of debate. The present study aimed to evaluate the optimum timing for drainage in patients with infected necrotizing pancreatitis. Methods: A prospective, observational study was undertaken at the Department of Surgery, Liaquat University of Medical & Health Sciences (LUMHS), between 1st March 2018 and 6th July 2020. All patients 18 years or older presenting with acute pancreatitis (AP) in whom necrotizing pancreatitis was confirmed or suspected were enrolled in the study. The exclusion criteria included prior intervention for necrotizing pancreatitis. Those who were diagnosed with infected necrotizing pancreatitis were labeled as Group A and Group B. Group A patients underwent immediate catheter drainage (within 24 h of admission) while Group B patients underwent delayed drainage (after 24 h). Clinical outcome variables including complication rate, mortality, length of hospital, and intensive care unit (ICU) stay were collected in a predefined pro forma.
One hundred and thirty patients were enrolled in the study. There were 65 patients in each group. The present study revealed no significant differences in patient outcomes in the immediate drainage group vs. the postponed drainage group. Overall, the mortality rate was 15.38% in Group A while the mortality rate was a little lower in Group B, i.e. 10.77% (p=0.44). The acute onset multiple organ failure was lower in Group A as compared to Group B, however, the difference was statistically insignificant (p=0.08). The rate of wound infection rate was 10.77% and 15.38% in Group A and Group B, respectively (p=0.61).
In the present study, we failed to find any significant difference between the immediate and postponed drainage group in terms of patient outcome. As per current findings, the timing of drainage did not impact the prognosis of patients with necrotizing pancreatitis.
感染性胰腺坏死的即刻或延迟导管引流仍是一个有争议的话题。本研究旨在评估感染性坏死性胰腺炎患者引流的最佳时机。方法：2018年3月1日至2020年7月6日在利亚卡特医学与健康科学大学（LUMHS）外科进行了一项前瞻性观察研究。所有18岁及以上出现急性胰腺炎（AP）且确诊或疑似坏死性胰腺炎的患者均纳入本研究。排除标准包括既往对坏死性胰腺炎进行过干预。那些被诊断为感染性坏死性胰腺炎的患者被分为A组和B组。A组患者接受即刻导管引流（入院后24小时内），而B组患者接受延迟引流（24小时后）。临床结局变量包括并发症发生率、死亡率、住院时间和重症监护病房（ICU）住院时间，通过预先定义的表格进行收集。
130名患者纳入本研究。每组65名患者。本研究显示，即刻引流组与延迟引流组在患者结局方面无显著差异。总体而言，A组死亡率为15.38%，B组死亡率略低，即10.77%（p = 0.44）。A组急性起病的多器官功能衰竭低于B组，然而，差异无统计学意义（p = 0.08）。A组和B组伤口感染率分别为10.77%和15.38%（p = 0.61）。
在本研究中，我们未发现即刻引流组与延迟引流组在患者结局方面有任何显著差异。根据目前的研究结果，引流时机并未影响坏死性胰腺炎患者的预后。
