Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Reserve Road, St Leonards, 2065 NSW, Australia.
Northern Clinical School, University of Sydney, St Leonards, Australia.
Surg Endosc. 2024 Nov;38(11):6973-6979. doi: 10.1007/s00464-024-11297-6. Epub 2024 Oct 4.
Minimally invasive surgical necrosectomy plays an important role in the management of infected pancreatic necrosis, with a goal of removing debris and debriding necrotic tissue. Pulse lavage is designed to simultaneously hydrostatically debride and remove the infected necrotic tissue with suction. It is also able to remove significant amounts of debris without traumatic manipulation of the necrotic tissue which may be adherent to surrounding tissue and can result in injury.
The surgical technique of utilising a waterjet pulse lavage device during the minimally invasive necrosectomy is detailed. Sixteen patients being managed via a step-up approach underwent endoscopic necrosectomy via a radiologically placed drain tract. All sixteen patients were successfully managed endoscopically without conversion to open necrosectomy, and survived their admission. There were no complications associated with the use of the waterjet pulse lavage.
Waterjet pulse lavage is a useful adjunct in minimally invasive necrosectomy, which reduces the length of the necrosectomy procedure, and facilitates removal of necrotic tissue while minimising the risk of traumatising healthy tissue.
微创外科清创术在感染性胰腺坏死的治疗中起着重要作用，其目的是清除坏死组织。脉冲灌洗旨在通过静水力学清创和抽吸同时清除感染性坏死组织。它还能够在不损伤可能与周围组织粘连的坏死组织的情况下清除大量的坏死组织，从而导致损伤。
详细介绍了在微创清创术中利用水射流脉冲冲洗装置的手术技术。16 例采用逐步治疗的患者通过放射学放置的引流管进行内镜下清创术。所有 16 例患者均成功地经内镜治疗，无需转为开放性清创术，且均存活。水射流脉冲冲洗无并发症。
水射流脉冲冲洗是微创清创术的有用辅助手段，可缩短清创术的时间，并在最小化损伤健康组织风险的情况下促进坏死组织的清除。
