背景:非手术方法,例如经皮引流对于治疗重症急性胰腺炎(SAP)患者至关重要。然而,关于腹腔穿刺置管和引流的最佳时机仍存在争议.
目的:探讨不同的腹腔穿刺置管时机对SAP并发腹腔积液引流的影响。
方法:使用回顾性方法,纳入184例SAP并发腹腔积液患者,根据导管放置时间分为三组:A组(症状发作2d内导管放置,n=89),B组(症状发作后第3天至第5天之间放置导管,n=55),和C组(症状发作后第6天和第7天之间的导管放置,n=40)。进展率的差异,死亡率,比较三组器官功能障碍的例数。
结果:A组的进展率明显低于B组和C组(2.25%vs21.82%和32.50%,P<0.05)。Further,A组至少有一个器官功能障碍的患者比例明显低于B组和C组(41.57%vs70.91%和75.00%,P<0.05)。A组的死亡率,B组,与C组相似(P>0.05)。术后第3天C反应蛋白水平(55.41±19.32mg/Lvs82.25±20.41mg/L和88.65±19.14mg/L,P<0.05),降钙素原(1.36±0.51ng/mLvs3.20±0.97ng/mL和3.41±0.98ng/mL,P<0.05),肿瘤坏死因子-α(15.12±6.63pg/Lvs22.26±9.96pg/L和23.39±9.12pg/L,P<0.05),白细胞介素-6(332.14±90.16ng/Lvs412.20±88.50ng/L和420.08±87.65ng/L,P<0.05),白细胞介素-8(415.54±68.43ng/Lvs505.80±66.90ng/L和510.43±68.23ng/L,P<0.05)和血清淀粉样蛋白A(270.06±78.49mg/Lvs344.41±81.96mg/L和350.60±80.42mg/L,P<0.05),A组明显低于B组和C组。A组住院时间明显低于B组和C组(24.50±4.16d比35.54±6.62d和38.89±7.10d,P<0.05)。A组住院费用也明显低于B组和C组[2.70(1.20,3.55)万元vs5.50(2.98,7.12)万元和6.00(3.10,8.05)万元,P<0.05)。A组并发症发生率明显低于C组(5.62%vs25.00%,P<0.05),与B组相似(P>0.05)。
结论:经皮穿刺置管引流术治疗SAP并发腹腔积液在发病2d内最有效。
BACKGROUND: Non-surgical methods such as percutaneous drainage are crucial for the treatment of patients with severe acute pancreatitis (SAP). However, there is still an ongoing debate regarding the optimal timing for abdominal paracentesis catheter placement and drainage.
OBJECTIVE: To explore the influence of different timing for abdominal paracentesis catheter placement and drainage in SAP complicated by intra-abdominal fluid accumulation.
METHODS: Using a retrospective approach, 184 cases of SAP complicated by intra-abdominal fluid accumulation were enrolled and categorized into three groups based on the timing of catheter placement: group A (catheter placement within 2 d of symptom onset, n = 89), group B (catheter placement between days 3 and 5 after symptom onset, n = 55), and group C (catheter placement between days 6 and 7 after symptom onset, n = 40). The differences in progression rate, mortality rate, and the number of cases with organ dysfunction were compared among the three groups.
RESULTS: The progression rate of group A was significantly lower than those in groups B and groups C (2.25% vs 21.82% and 32.50%, P < 0.05). Further, the proportion of patients with at least one organ dysfunction in group A was significantly lower than those in groups B and groups C (41.57% vs 70.91% and 75.00%, P < 0.05). The mortality rates in group A, group B, and group C were similar (P > 0.05). At postoperative day 3, the levels of C-reactive protein (55.41 ± 19.32 mg/L vs 82.25 ± 20.41 mg/L and 88.65 ± 19.14 mg/L, P < 0.05), procalcitonin (1.36 ± 0.51 ng/mL vs 3.20 ± 0.97 ng/mL and 3.41 ± 0.98 ng/mL, P < 0.05), tumor necrosis factor-alpha (15.12 ± 6.63 pg/L vs 22.26 ± 9.96 pg/L and 23.39 ± 9.12 pg/L, P < 0.05), interleukin-6 (332.14 ± 90.16 ng/L vs 412.20 ± 88.50 ng/L and 420.08 ± 87.65ng/L, P < 0.05), interleukin-8 (415.54 ± 68.43 ng/L vs 505.80 ± 66.90 ng/L and 510.43 ± 68.23ng/L, P < 0.05) and serum amyloid A (270.06 ± 78.49 mg/L vs 344.41 ± 81.96 mg/L and 350.60 ± 80.42 mg/L, P < 0.05) were significantly lower in group A compared to those in groups B and group C. The length of hospital stay in group A was significantly lower than those in groups B and group C (24.50 ± 4.16 d vs 35.54 ± 6.62 d and 38.89 ± 7.10 d, P < 0.05). The hospitalization expenses in group A were also significantly lower than those in groups B and groups C [2.70 (1.20, 3.55) ten-thousand-yuan vs 5.50 (2.98, 7.12) ten-thousand-yuan and 6.00 (3.10, 8.05) ten-thousand-yuan, P < 0.05). The incidence of complications in group A was markedly lower than that in group C (5.62% vs 25.00%, P < 0.05), and similar to group B (P > 0.05).
CONCLUSIONS: Percutaneous catheter drainage for the treatment of SAP complicated by intra-abdominal fluid accumulation is most effective when performed within 2 d of onset.