Li Jinjian, Huang Zihao, Shen Bo, Yu Hong
Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
BMC Gastroenterol. 2025 Jul 1;25(1):472. doi: 10.1186/s12876-025-04001-y.
Laparoscopic retroperitoneal necrosectomy (LRN) is a novel minimally invasive approach for treating infected necrotizing pancreatitis. Our study aims to evaluate the safety and effectiveness of LRN for pancreatic necrosis at a single center.
This retrospective study analyzed 120 patients who had laparoscopic retroperitoneal necrosectomy (LRN) for necrotizing pancreatitis at Sir Run Run Shaw Hospital from November 2017 to May 2023, with a six-month follow-up. Patients included had no prior surgeries. We evaluated the incidence of postoperative complications and mortality rates. Furthermore, subgroup analyses were performed to assess mortality and complications, utilizing univariate and multivariate regression analyses to identify associated risk factors.
Among the 120 patients, complications classified as Clavien-Dindo grade ≥ III occurred in 34.2%, and 8.3% experienced surgery-related mortality. In the multivariate regression analysis of complications classified as Clavien-Dindo grade ≥ III, length of stay (LOS) in the ICU (OR = 1.026;95% confidence interval [CI], 1.005 to 1.047; P = 0.015), and the presence of extrapancreatic infections (OR = 3.656;95% confidence interval [CI], 1.443to 9.261; P = 0.006) were identified as risk factors. A total of 77 patients with severe acute pancreatitis (according to the modified Atlanta classification) were included in the study. After 48 h of treatment, the SOFA score significantly decreased (5.92 ± 4.56 vs. 4.06 ± 3.44; P < 0.01), and the CT severity index (CTSI) also significantly decreased at one week post-surgery (7.57 ± 2.29 vs. 6.23 ± 2.28; P < 0.01). CRP levels (144.34 ± 77.45 vs. 87.94 ± 67.63; P < 0.01) and WBC count (10.97 ± 6.84 vs. 9.95 ± 6.79; P = 0.048) significantly decreased within one week after surgery. Among the 23 patients with preoperative hemodynamic instability, 13 required only a single surgery, while 4 required conversion to open surgery. At 48 h post-surgery, the SOFA score significantly decreased (8.74 ± 5.71 vs. 6.17 ± 4.94; P = 0.021), and the CTSI at one week was also considerably lower (8.26 ± 2.03 vs. 6.78 ± 2.04; P < 0.01).
LRN allows over 70% of patients to avoid multiple surgeries while achieving excellent therapeutic outcomes. Furthermore, it is particularly effective for critically ill patients with hemodynamic instability, offering a distinct advantage over alternative treatments. Thus, LRN represents a promising therapeutic approach deserving of broader adoption.
腹腔镜腹膜后坏死组织清除术（LRN）是一种治疗感染性坏死性胰腺炎的新型微创方法。我们的研究旨在评估单中心LRN治疗胰腺坏死的安全性和有效性。
这项回顾性研究分析了2017年11月至2023年5月在邵逸夫医院接受腹腔镜腹膜后坏死组织清除术（LRN）治疗坏死性胰腺炎的120例患者，并进行了为期6个月的随访。纳入的患者既往未接受过手术。我们评估了术后并发症的发生率和死亡率。此外，进行亚组分析以评估死亡率和并发症，利用单因素和多因素回归分析确定相关危险因素。
120例患者中，Clavien-Dindo分级≥III级的并发症发生率为34.2%，手术相关死亡率为8.3%。在Clavien-Dindo分级≥III级并发症的多因素回归分析中，重症监护病房（ICU）住院时间（OR = 1.026；95%置信区间[CI]，1.005至1.047；P = 0.015）和胰腺外感染的存在（OR = 3.656；95%置信区间[CI]，1.443至9.261；P = 0.006）被确定为危险因素。本研究共纳入77例重症急性胰腺炎（根据改良亚特兰大分类法）患者。治疗48小时后，序贯器官衰竭评估（SOFA）评分显著降低（5.92±4.56对4.06±3.44；P < 0.01），术后1周计算机断层扫描严重程度指数（CTSI）也显著降低（7.57±2.29对6.23±2.28；P < 0.01）。术后1周内，C反应蛋白（CRP）水平（144.34±77.45对87.94±67.63；P < 0.01）和白细胞计数（10.97±6.84对9.95±6.79；P = 0.048）显著降低。23例术前存在血流动力学不稳定的患者中，13例仅需进行一次手术，4例需要转为开放手术。术后48小时，SOFA评分显著降低（8.74±5.71对6.17±4.94；P = 0.021），术后1周的CTSI也显著降低（8.26±2.03对6.78±2.04；P < 0.01）。
LRN可使70%以上的患者避免多次手术，同时取得良好的治疗效果。此外，它对血流动力学不稳定的重症患者特别有效，比其他治疗方法具有明显优势。因此，LRN是一种有前景的治疗方法，值得更广泛地采用。
