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Abstract：
BACKGROUND: About 20% of patients with acute pancreatitis develop a necrotising form with a worse prognosis due to frequent appearance of organ failure(s) and/or infection of necrosis. Aims of the present study was to evaluate the \"step up\" approach treatment of infected necrosis in terms of: feasibility, success in resolving infection, morbidity of procedures, risk factors associated with death and long-term sequels.
METHODS: In this observational retrospective monocentric study in the real life, necrotizing acute pancreatitis at the stage of infected walled-off necrosis were treated as follow: first step with drainage (radiologic and/or endoscopic-ultrasound-guided with lumen apposing metal stent); in case of failure, minimally invasive necrosectomy sessions(s) by endoscopy through the stent and/or via retroperitoneal surgery (step 2); If necessary open surgery as a third step. Efficacy was assessed upon to a composite clinical-biological criterion: resolution of organ failure(s), decrease of at least two of clinico-biological criteria among fever, CRP serum level, and leucocytes count).
RESULTS: Forty-one consecutive patients were treated. The step-up strategy: (i) was feasible in 100% of cases; (ii) allowed the infection to be resolved in 33 patients (80.5%); (iii) Morbidity was mild and rapidly resolutive; (iv) the mortality rate at 6 months was of 19.5% (significant factors: SIRS and one or more organ failure(s) at admission, fungal infection, size of the largest collection ≥ 16 cm). During the follow-up (median 72 months): 27% of patients developed an exocrine pancreatic insufficiency, 45% developed or worsened a previous diabetes, 24% had pancreatic fistula and one parietal hernia.
CONCLUSIONS: Beside a very good feasibility, the step-up approach for treatment of infected necrotizing pancreatitis in the real life displays a clinico-biological efficacy in 80% of cases with acceptable morbidity, mortality and long-term sequels regarding the severity of the disease.
METHODS: In this observational retrospective monocentric study in the real life, necrotizing acute pancreatitis at the stage of infected walled-off necrosis were treated as follow: first step with drainage (radiologic and/or endoscopic-ultrasound-guided with lumen apposing metal stent); in case of failure, minimally invasive necrosectomy sessions(s) by endoscopy through the stent and/or via retroperitoneal surgery (step 2); If necessary open surgery as a third step. Efficacy was assessed upon to a composite clinical-biological criterion: resolution of organ failure(s), decrease of at least two of clinico-biological criteria among fever, CRP serum level, and leucocytes count).
RESULTS: Forty-one consecutive patients were treated. The step-up strategy: (i) was feasible in 100% of cases; (ii) allowed the infection to be resolved in 33 patients (80.5%); (iii) Morbidity was mild and rapidly resolutive; (iv) the mortality rate at 6 months was of 19.5% (significant factors: SIRS and one or more organ failure(s) at admission, fungal infection, size of the largest collection ≥ 16 cm). During the follow-up (median 72 months): 27% of patients developed an exocrine pancreatic insufficiency, 45% developed or worsened a previous diabetes, 24% had pancreatic fistula and one parietal hernia.
CONCLUSIONS: Beside a very good feasibility, the step-up approach for treatment of infected necrotizing pancreatitis in the real life displays a clinico-biological efficacy in 80% of cases with acceptable morbidity, mortality and long-term sequels regarding the severity of the disease.
摘要：
背景：由于频繁出现器官衰竭和/或感染坏死，约20％的急性胰腺炎患者出现坏死形式，预后较差。本研究的目的是评估“加强”方法治疗感染坏死的可行性，成功解决感染，程序的发病率，与死亡和长期后遗症相关的危险因素。
方法：在现实生活中的观察性回顾性单中心研究中，坏死性急性胰腺炎在感染壁坏死阶段的治疗如下：第一步引流（放射和/或内窥镜超声引导腔内贴壁金属支架）;在失败的情况下，通过内窥镜检查通过支架和/或通过腹膜后手术（第2步）进行微创坏死切除术；如有必要，开放手术作为第三步。根据复合临床生物学标准评估功效：器官衰竭的解决，发热中至少有两项临床生物学标准下降，CRP血清水平,和白细胞计数）。
结果：治疗了41例患者。加强策略：（i）在100％的病例中是可行的；（ii）允许33例患者（80.5％）的感染得以解决；（iii）发病率轻度且迅速消退；（iv）6个月的死亡率为19.5％（重要因素：SIRS和入院时的一个或多个器官衰竭，真菌感染,最大集合的尺寸≥16厘米)。在随访期间（中位数72个月）：27％的患者出现胰腺外分泌功能不全，45％的人发展或恶化了以前的糖尿病，24%有胰瘘和一个顶叶疝。
结论：除了一个非常好的可行性，在现实生活中治疗感染性坏死性胰腺炎的逐步方法在80％的发病率可接受的病例中显示出临床生物学功效，死亡率和疾病严重程度的长期后遗症。
方法：在现实生活中的观察性回顾性单中心研究中，坏死性急性胰腺炎在感染壁坏死阶段的治疗如下：第一步引流（放射和/或内窥镜超声引导腔内贴壁金属支架）;在失败的情况下，通过内窥镜检查通过支架和/或通过腹膜后手术（第2步）进行微创坏死切除术；如有必要，开放手术作为第三步。根据复合临床生物学标准评估功效：器官衰竭的解决，发热中至少有两项临床生物学标准下降，CRP血清水平,和白细胞计数）。
结果：治疗了41例患者。加强策略：（i）在100％的病例中是可行的；（ii）允许33例患者（80.5％）的感染得以解决；（iii）发病率轻度且迅速消退；（iv）6个月的死亡率为19.5％（重要因素：SIRS和入院时的一个或多个器官衰竭，真菌感染,最大集合的尺寸≥16厘米)。在随访期间（中位数72个月）：27％的患者出现胰腺外分泌功能不全，45％的人发展或恶化了以前的糖尿病，24%有胰瘘和一个顶叶疝。
结论：除了一个非常好的可行性，在现实生活中治疗感染性坏死性胰腺炎的逐步方法在80％的发病率可接受的病例中显示出临床生物学功效，死亡率和疾病严重程度的长期后遗症。
