Avudiappan Mohanasundaram, Bhargava Venu, Kulkarni Aditya, Kang Mandeep, Rana Surinder Singh, Gupta Rajesh
Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Department of Radio Diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Surg Open Sci. 2023 Jul 19;15:38-42. doi: 10.1016/j.sopen.2023.07.004. eCollection 2023 Sep.
The conventional open necrosectomy was associated with high mortality and morbidities like secondary organ failure, incisional hernia, enterocutaneous fistula, and external pancreatic fistula. In acute pancreatitis, collections are primarily confined to the retroperitoneal space. Hence, the retroperitoneal approach can be used to drain the collection and necrotic material. It benefits smaller incisions and better outcomes in terms of morbidity and mortality than the conventional open necrosectomy. This study primarily aims to describe the effects of minimal incision retroperitoneal necrosectomy versus conventional open necrosectomy for treating INP. Moreover, it provides evidence supporting the efficacy and safety of this method.
A single-center retrospective study of the prospectively maintained database from April 2008 to December 2021.
A total of 122 patients were included in the study. Seventy-eight patients had an open necrosectomy, 30 had a MIRN, and 14 had a VARD procedure. These three groups were comparable in demographic variables. Preoperative variables like APACHE II at presentation, Modified CTSI, percentage of necrosis, multi-organ failure, time to surgery, and need for preoperative ICU stay were comparable among the three groups. Postoperative mortality was low in the MIRN group{open 35.8 % vs. MIRN 20.5 % vs. VARD 35.7 %, = 0.066}. The postoperative stay was also significantly low in the MIRN and VARD group {open 23.62 ± 16.61 vs. MIRN 11.77 ± 7.73, VARD 8.86 ± 2.98, = 0.00}. No significant difference in re-intervention rate, postoperative bleeding, and enterocutaneous fistula.
MIRN is a simple and easy-to-adapt procedure for infected pancreatic necrosis in the appropriately selected patient group.
传统开放性坏死组织清除术与高死亡率及多种并发症相关，如继发性器官衰竭、切口疝、肠皮肤瘘和胰外瘘。在急性胰腺炎中，积液主要局限于腹膜后间隙。因此，可采用腹膜后入路引流积液和坏死物质。与传统开放性坏死组织清除术相比，它具有切口更小、发病率和死亡率方面预后更好的优势。本研究主要目的是描述微创腹膜后坏死组织清除术与传统开放性坏死组织清除术治疗感染性坏死性胰腺炎（INP）的效果。此外，还提供支持该方法有效性和安全性的证据。
对2008年4月至2021年12月前瞻性维护的数据库进行单中心回顾性研究。
本研究共纳入122例患者。78例行开放性坏死组织清除术，30例行微创腹膜后坏死组织清除术（MIRN），14例行视频辅助腹膜后清创术（VARD）。这三组在人口统计学变量方面具有可比性。术前变量如入院时急性生理与慢性健康状况评分系统II（APACHE II）、改良CT严重指数（Modified CTSI）、坏死百分比、多器官衰竭、手术时间以及术前入住重症监护病房的需求在三组之间具有可比性。MIRN组术后死亡率较低{开放性坏死组织清除术组为35.8%，MIRN组为20.5%，VARD组为35.7%，P = 0.066}。MIRN组和VARD组术后住院时间也显著缩短{开放性坏死组织清除术组为23.62±16.61天，MIRN组为11.77±7.73天，VARD组为8.86±2.98天，P = 0.00}。再次干预率、术后出血和肠皮肤瘘方面无显著差异。
对于适当选择的患者群体，MIRN是一种治疗感染性胰腺坏死的简单且易于应用的手术方法。
