Margulies A G, Akin H E
Department of Surgery, University of Tennessee Medical Center-Knoxville, 37920, USA.
Am Surg. 1997 Mar;63(3):261-5.
Infected pancreatic necrosis is a devastating and lethal complication of acute pancreatitis. Late death is usually a result of sepsis. W.A. Altemeier and J.W. Alexander established in 1963 that open drainage of the necrotic pancreas is mandatory for survival (Arch Surg 1963;87:96-105). In 1981, E.D. Davidson and E.L. Bradley III concluded that "marsupialization" is the most effective method of open drainage (Surgery 1981;89:252-6). At our institution, we have a series of 10 patients who have undergone marsupialization for treatment of infected pancreatic necrosis. Our mortality rate was 30 per cent. One death resulted from sepsis after an infected necrotic pancreas was found with a colonic anastomotic leak at emergency exploratory celiotomy. Of note, further debridement was not performed. A second death occurred in a female with idiopathic pancreatitis and leukocytopenia, and we are uncertain whether that played a role in the failure of surgical intervention. The third death was in a young alcoholic with hyperlipidemia and severe pancreatitis who was septic 8 days before surgery. The patient died on postoperative day 1. Of the survivors, some were old, many were septic, and all but one returned for further debridement. Our series supports open debridement of infected pancreatic necrosis as a life-saving maneuver and marsupialization as an effective means of open drainage.
感染性胰腺坏死是急性胰腺炎的一种毁灭性且致命的并发症。晚期死亡通常是脓毒症所致。1963年，W.A. 阿尔特迈尔和J.W. 亚历山大证实，坏死胰腺的开放引流是生存的必要条件（《外科学文献》1963年；87卷：96 - 105页）。1981年，E.D. 戴维森和E.L. 布拉德利三世得出结论，“袋形缝术”是开放引流的最有效方法（《外科学》1981年；89卷：252 - 256页）。在我们机构，有一组10例因感染性胰腺坏死接受袋形缝术治疗的患者。我们的死亡率为30%。1例死亡是在急诊剖腹探查术中发现感染性坏死胰腺合并结肠吻合口漏后因脓毒症导致的。值得注意的是，未进行进一步清创。第2例死亡发生在一名患有特发性胰腺炎和白细胞减少症的女性患者身上，我们不确定这是否与手术干预失败有关。第3例死亡是一名患有高脂血症和重症胰腺炎的年轻酗酒者，术前8天发生脓毒症。该患者术后第1天死亡。在幸存者中，一些患者年龄较大，许多患者发生脓毒症，除1人外所有人都返回接受进一步清创。我们的病例系列支持将感染性胰腺坏死的开放清创作为一种挽救生命的措施，以及将袋形缝术作为开放引流的有效手段。
