Tsiotos G G, Luque-de León E, Söreide J A, Bannon M P, Zietlow S P, Baerga-Varela Y, Sarr M G
Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Am J Surg. 1998 Feb;175(2):91-8. doi: 10.1016/s0002-9610(97)00277-8.
From 1983 to 1995, 72 patients with necrotizing pancreatitis were treated with a general approach involving planned reoperative necrosectomies and interval abdominal wound closure using a zipper.
Hospital mortality was 25%. Multiple organ failure without sepsis caused early mortality in 3 of 4 patients and sepsis caused late mortality in 11 of the remaining 14. The mean number of reoperative necrosectomies/debridements was 2 (0 to 7). Fistulae developed in 25 patients (35%); 64% were treated conservatively. Recurrent intraabdominal abscesses developed in 9 patients (13%) but were drained percutaneously in 5. Hemorrhage required intervention in 13 patients (18%). Prognostic factors included APACHE-II score on admission < 13 (P = 0.005), absence of postoperative hemorrhage (P = 0.01), and peripancreatic tissue necrosis alone (P < 0.05).
The zipper approach effectively maximizes the necrosectomy and decreases the incidence of recurrent intraabdominal infection requiring reoperation. APACHE-II score > or = 13, extensive parenchymal necrosis, and postoperative hemorrhage signify worse outcome.
1983年至1995年期间，72例坏死性胰腺炎患者接受了一种综合治疗方法，包括计划性再次手术坏死组织清除术以及使用拉链进行分期腹部伤口闭合。
医院死亡率为25%。4例患者中有3例因无脓毒症的多器官功能衰竭导致早期死亡，其余14例中的11例因脓毒症导致晚期死亡。再次手术坏死组织清除术/清创术的平均次数为2次（0至7次）。25例患者（35%）发生了瘘；64%接受了保守治疗。9例患者（13%）出现复发性腹腔内脓肿，但其中5例经皮引流。13例患者（18%）因出血需要干预。预后因素包括入院时APACHE-II评分<13（P = 0.005）、无术后出血（P = 0.01）以及仅存在胰周组织坏死（P < 0.05）。
拉链法能有效最大化坏死组织清除，并降低需要再次手术的复发性腹腔内感染的发生率。APACHE-II评分≥13、广泛的实质坏死以及术后出血预示预后较差。
