背景:完全清除坏死对于治疗表现为胰腺坏死(IPN)感染的重症急性胰腺炎(SAP)患者至关重要。经常使用的微创方法包括适合于坏死横向延伸的手术阶梯方法,而内窥镜增强方法适用于内侧坏死。然而,在广泛的IPN患者中,这两种方法通常都有有限的治疗效果。
方法:我们描述了一系列用于治疗广泛IPN的联合微创升压方法。
方法:患者被诊断为SAP并有广泛的IPN。
方法:纳入7例SAP和广泛IPN患者。所有患者均接受了包括4个步骤的联合加强方法:经皮导管引流,连续负压灌溉(CNPI),经皮内镜下坏死切除术(PEN),和经胃坏死切除术(TN)。
结果:从症状发作到经皮导管引流和CNPI的中位间隔为11天(范围,6-14)和18天(范围,14-26),CNPI持续时间中位数为84天(范围,54-116).从症状发作到PEN和TN的中位间隔为36天(范围,23-42)和41天(范围,34-48),分别,手术的中位数为2(范围,1-2)对于PEN和3(范围,2-4)用于TN。仅报告了少量的腹腔出血和胰皮瘘,两者在保守治疗后都得到了解决。在重症监护病房的平均住院时间为111天(范围,73-133);所有患者均存活。
结论:这种微创逐步升级方法在具有广泛IPN和高风险手术干预的危重患者中显示出良好的临床效果,并且相对安全。
BACKGROUND: Complete removal of necrosis is critical for treating patients with severe acute pancreatitis (SAP) presenting infection of pancreatic necrosis (IPN). Frequently used mini-invasive methods include the surgical step-up approach suitable for necrosis extending laterally, whereas the endoscopic step-up approach is suitable for medial necrosis. However, in patients with extensive IPN, either approach alone usually has limited treatment effects.
METHODS: We describe a
case series of combined mini-invasive step-up approach for treating extensive IPN.
METHODS: Patients were diagnosed with SAP and had extensive IPN.
METHODS: Seven patients with SAP and extensive IPN were enrolled. All patients underwent a combined step-up approach comprising 4 steps: percutaneous catheter drainage, continuous negative pressure irrigation (CNPI), percutaneous endoscopic necrosectomy (PEN), and transgastric necrosectomy (TN).
RESULTS: The median interval from symptom onset to percutaneous catheter drainage and CNPI was 11 days (range, 6-14) and 18 days (range, 14-26), and the median CNPI duration was 84 days (range, 54-116). The median interval from the onset of symptoms to PEN and TN was 36 days (range, 23-42) and 41 days (range, 34-48), respectively, and the median number of procedures was 2 (range, 1-2) for PEN and 3 (range, 2-4) for TN. Only a minor
case of abdominal bleeding and a pancreatic-cutaneous fistula were reported, both resolved after conservative treatment. The median length of stay in the intensive care unit was 111 days (range, 73-133); all patients survived.
CONCLUSIONS: This mini-invasive step-up approach shows promising clinical effects and is relatively safe in critically ill patients with extensive IPN and high-risk surgical intervention.