Evaluation of resting energy expenditure in critically ill surgical patients receiving mechanical ventilation / 中华临床营养杂志

ObjectiveTo assess and compare the resting energy expenditure measured by indirect calorimetry (MREE) and calculated with Harris-Benedict formula adjusted with correction factors (CREE) in critically ill surgical patients receiving mechanical ventilation,and to evaluate the relationship between resting energy expenditure and the severity of diseases.MethodsFrom August 2008 to February 2010,21 patients fitting the inclusion criteria were selected into the present study.The data of the patients were collected to calculate acute physiology and chronic health evaluation Ⅱ score ( APACHE Ⅱ score) and multiple organ dysfunction score ( Marshall score).MREEs were measured using indirect calorimetry of a MedGraphics CCM/D System,and CREEs were calculated at the same time with the Harris-Benedict formula.ResultsWithin the week of nutrition support,the mean CREE of the 21 patients was significantly higher than the mean MREE [ ( 8305.09 ± 1392.76 ) kJ vs.(6544.84 ±2079.65) kJ,P =0.000].The differences between MREE and CREE were statistically significant on the 0 ( P =0.000),1 ( P =0.000 ),2 ( P =0.000 ),and 4 day ( P =0.003 ) of nutritional support.There was no correlation between MREE and CREE (r =0.064,P =0.408 ),nor between MREE and APACHE Ⅱ ( r=-0.045,P =0.563 ).There was a correlation between MREE and Marshall score (P =0.001 ),but the correlation coefficient was low ( r =0.263).ConclusionsThe Harris-Benedict prediction modified with correction factors for severity of diseases overestimates the resting energy expenditure of critically ill surgical patients.Indirect calorimetry is a more accurate method for determining resting enenrgy expenditure.

Prophylactic antibiotics in severe acute pancreatitis: a meta-analysis / 中华肝胆外科杂志

Objective To carry out a meta-analysis on the published data in order to evaluate the clinical efficacy of prophylactic antibiotics in severe acute pancreatitis (SAP). Methods We searched the MEDLINE, EMBASE, Cochrane data base for systematic reviews and China biological medicine for randomized controlled trials on the efficacy of prophylactic antibiotics in patients with SAP from 1975 to May 2010. Eight studies met the inclusion criteria. Two authors independently extracted the data from these studies. The data were analyzed using the RevMan 4. 2. 10 software. Result In patients with SAP, prophylactic antibiotics did not reduce pancreatic infection (OR = 0. 67,95% CI:0. 43～1. 02,P = 0. 06), surgical intervention (OR = 0. 90,95% CI: 0. 60～ 1. 36 ,P = 0. 63) and mortality rate (OR = 0. 69,95% CI: 0. 41～1. 15,P=0. 16). Conclusion Antibiotic prophylaxis of SAP did not reduce mortality. It did not protect against pancreatic infection and the frequency of surgical intervention.

Early goal-directed therapy in severe acute pancreatitis / 中华肝胆外科杂志

Objective To study the difference in outcomes between two treatment regimens of goal-directed fluid therapy in patients with severe acute pancreatitis. Methods From January 2000 to January 2010, 80 patients with severe acute pancreatitis were assigned into 2 groups. In group A,patients received fluid therapy aiming at the following goals in 24 hours: (1) Blood pressure >90/60 mm Hg;(2) CVP between 8-12 mm Hg;(3) Urine output >0. 5 ml · kg-1 · h-1. In group B, patients received fluid therapy aiming at the following goals in 6 hours (according to SSC guideline,2004): (1) mean arterial blood pressure >65 mm Hg;(2) CVP between 8-12 mm Hg;(3) Urine output >0. 5 ml · kg-1 · h-1 ;(4) central venous oxygen saturation >70%. After therapy for 3 days we measured the Marshall score, APACHE Ⅱ score, and the peri-pancreatic infection and mortality rates. Results The Marshall score was 6. 82±4. 69 and 4. 48±3. 78 in group A and B, respectively (P=0. 02). The APACHE Ⅱ score was 11. 35±5. 96 and 8. 22±4. 53 in group A and B, respectively (P=0. 01). The peri-pancreatic infection rate was 44% and 37% in group A and B, respectively, and there was no significant difference between the 2 groups (P = 0. 65). The mortality rate was 24% and 17% in group A and B. There was no significant difference between the 2 groups(P=0. 57). Conclusion Goal-directed fluid therapy in patients with severe acute pancreatitis according to the SSC guideline improved organ function but it did not reduce peri-pancreatic infection and mortality rates.

Determination of energy expenditure in mechanically ventilated patients / 中华临床营养杂志

Objective To investigate the energy expenditure of mechanically ventilated patients,compare the measured energy expenditure (MREE) with the energy expenditure expected from the Harris-Benedict equation adjusted with correction factors (PREE). Methods Twenty-four critically ill adult patients who were mechanically ventilated in the intensive care unit were enrolled in this study. Data during the 72 hours of mechanical ventilation were collected for computation of severity of illness. Resting energy expenditures were derived at 72hours after mechanical ventilation by indirect calorimetry. Predicted basal energy expenditure was obtained at the same time using the Harris-Benedict equation and predicted resting energy expenditure was calculated using the Harris-Benedict value adjusted with correction factors for illness. Results The Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ)scores and Marshall scores were 14 ± 5 and 6 ± 3, respectively. MREE and PREE were (6 793.64 ± 1 197.15) and (8 041.02 ± 1 971.54) kJ/day, respectively. There was no correlation between MREE and PREE (r2 = 0. 28, P = 0. 07), and the difference between MREE and PREE was statistically significant (t = 7.62, P = 0.04). No statistically significant correlations were observed between both MREE or PREE and APACHE Ⅱ score or Marshall score (r2 = 0. 14, P = 0. 08; r2= 0. 08, P = 0. 63; r2 = 0. 05, P =0. 65; r2 = 0.03, P = 0. 87, respectively). Conclusions In mechanically ventilated patients, the energy expenditure is not correlated with the severity of illness. The Harris-Benedict prediction modified with correction factors for severity of illness systematically overestimates the total energy expenditure.

Primary resection and anastomosis with intraoperative colonic defecation in left colonic cancer with complete obstruction / 国际外科学杂志

Objective To assess the value of primary resection and anastomosis with intraoperative colonic defecation in the patients with obstructive left colonic cancer. Methods From January 2000 to January 2008, 39 patients undergoing emergency laparotomy for left colonic cancers with complete obstruction were analyzed retrospectively. Results The patients were 25 males and 14 females, with a median age of 68.5 years (range: 57～78 years). The primary tumors were located at splenic flexure (3/7.7%), descending colon (8/20.5%), sigmoid colon (15/38.5%), boundary of sigmoid colon and rectum (8/20.5%), and superior segment of rectum (5/12.8%). Primary resection and anastomosis with intraoperative colonic de-fection were performed in 18 patients with left hemicolectomy, 13 patients with sigmoid colectomy and 8 pa-tients with anterior resection. Early complications included wound infection in 4 patients (wound disruption in 1 patient) and pulmonary infection in 5 patients. One patient complicated with anastomotic leakage and intra-abdominal abscess died of tumor metastasis after reoperation. Another one died of respiratory failure secondary to pulmonary infection. Morbidity and mortality was 25.6% and 5.1% respectively. Conclusion Primary resection with intraoperative colonic defecation can be applied to patients with malignant colonic complete obstruction with good operative results.

Relationship between intra-abdominai pressure and severity in pathents with severe acute pancreatitis / 中华急诊医学杂志

Objective Previous investigations suggest that severe acute pancreatitis (SAP) is one of the main causes of intra-ahdominal pressure (lAP) increase. The aims of this study were, to evaluate the increased IAP in patients with SAP and the correlation between LAP and severity or prognosis. Method Data of 75 SAP patients admitted to Xuan-Wu Hospital of Capital Medical University intensive care unit with SAP from January 2000 to Jan-uary 2008 were collected. All the patients had at least one organ dysfunction, and they were diagnozed with en-hanced CT, lAP were monitored in the 56 patients. The 56 patients were divided into three groups according to IAP, group A (7- 15 mmHg), group B (16-25 mmHg) and group C (26-31 mmHg). Maximal APECHE Ⅱscore, maximal Ranson score, maximal C-response protein (CRP), maximal arterial lactate, maximal creatinine, organ dysfunction, length of stay and mortality were compared. Results The 56 patients (24 male and 32 female)with average age of (52±14.1) years (ranging 21 - 72 years) and average body mass index (BMI) of 28±12.5(ranging 21 - 35) were monitored with IAP. The etiologic causes of SAP were biliary in 27 patients, alcohol in 14cases, hyperlipidemia in 11 cases and idiopathic in 4 cases. The rate of intra-abdominal hypertension was 89% (50/56), and 32% (18/56) patients complicated with abdominal compartment syndrome. There were 22, 26 and 8 patients in the A, B and C groups respectively. With the increasing of IAP, the maximal APACHE Ⅱ, maximal Ranson score, maximal CRP, maximal creatinine, organ dysfunction and mortality were also increased significant-ly. The mortality of the three groups was 13.6% (3/22), 23.1% (6/26) and 62.5% (5/8) respectively (χ2 =7.56, p = 0.023), and the total mortality of the 56 patients was 25%. The hospital stay of the three groups had no significant differenee(F = 2.23,P = 0.117). Conclusions IAP may be one of the markers used to evaluate the severity of SAP, and the monitoring of IAP is useful to assess the prognosis in patients with SAP.

Clinical profiles of hyperlipidemic pancreatitis / 中华胰腺病杂志

event and treat circular,respiratory and renal insufficiency.

Immune nutrition in the treatment of acute pancreatitis / 国际外科学杂志

Acute pancreatitis can lead to dysfunction of gut mucosa barrier, translocation of intestinal bacteria, damage of immune function. Immune nutrition substances such as glutamine, arginine, -3 polyun-saturated fatty acids (-3 PUFAs),dietary fiber (DF) can prevent dysfunction of gut mucosa barrier and translocation of intestinal bacteria, enhance the immune function, promote the recovery of acute pancreatitis. The article reviewed domestic and. overseas documents to on the contribution of immune function to acute pancreatitis.

N-acetylcysteine decreases the severity of pancreatic injury in rats with acute necrotizing pancreatitis / 中华普通外科杂志

Objective To investigate the correlation between pancreatic nuclear factor-κB (NF-κB) activation, cell apoptosis and pancreatic injury. To determine effects of N-acetylcysteine (NAC) on pancreatic injury in rats with acute necrotizing pancreatitis (ANP). Methods Thirty-three Wistar rats were divided into five groups: normal group, normal saline (NS) group, ANP group, prophylactic and therapeutic groups with NAC randomly. ANP was produced by 3.5% sodium taurocholate retrograde injection. In the prophylactic group, rats received intravenous (i. v.) injection of NAC (300 mg/kg) 1 hour before taurocholate injection and in the therapeutic group, NAC i.v. injection was given 1 hour after sodium taurocholate injection. Animals were sacrificed at 12 hours after induction of pancreatitis. Activation of NF-KB in pancreatic tissues was determined by electrophoretic mobility shift assay(EMSA). Cell apoptosis was assessed by modified TUNEL method. The following parameters were also measured: plasma levels of amylase and lipase, pancreatic wet/dry weight ratio and histologic grading. Results Taurocholate pancreatitis is characteristic of necrosis, haemorrhage, and severe leukocyte infiltration in the pancreas. Plasma amylase and lipase levels, pancreatic wet/dry weight ratio increased in rats of ANP. NF-κB banding activity was higher after pancreatitis induction (6.03±0.41). When NAC was given 1 hour before induction of pancreatitis, the activation (3.28±0.42) of NF-κB was prevented with significantly decreased severity of pancreatitis as assessed by amylase, pancreatic wet/dry weight ratio. The number of apoptotic cells in pancreatic tissue sections was greater in rats treated with NAC than in rats not treated with NAC. There was a negative correlation between NF-κB banding activity and apoptosis of pancreatic cells (r=-0.96, P< 0.01) and there was a positive correlation between NF-κB activation and histopathological score (r=0.63, P<0.01). Histopathological score of pancreatic injury had negative correlation with apoptosis of pancreatic cells(r=-0.98, P<0.01). Conclusion Early blocked NF-κB activation with NAC increases cell apoptosis in pancreatic tissue and decreases edema of pancreas and severity of pancreatitis in rats with ANP.

Primary resection and anastomosis without intraoperative colonic irrigation in left colonic cancer with complete obstruction / 中华急诊医学杂志

Objective To assess the value of primary resection and anastomosis without intraoperative irrigation in the patients with obstructive left colonic cancer. Method Between January 2000 and January 2008, 93patients underwent primary resection and anastomosis for colonic cancers were analyzed retrospectively. Primary resection and anastomosis without intraoperative colonic irrigation (decompression by manual defecation) was performed in 43 patients with obstructive left colonic caner and traditional left-sided colectomy in 50 cases without obstruction. Both groups of patients were comparable in terms of gender, nutritional status, underlaying disease, tumor location and stage, etc ( P = 0.83,0.13,0.29,0.51,0.38). The average age of the patients with colonic obstruction was significant older than that of the cases without obstruction (61.2 ± 8.6 vs. 58.1 ±7.8, P =0.010).The operative results were compared between patients with obstructive colonic cancer and cases without obstruction.Results The mean hospital stay of the primary anastomosis group and traditional left-sided colectomy group were (16.6±7.8) d and (12.4±5.4) d respectively, and the former was significant longer than the latter (P =0.002). The costs of hospitalization in the two groups were (50192.8 ± 39727.4) RMB and (46489.3 ±29543.1)RMB respectively (P = 0.04) . The morbidity and mortality in the two groups were 25.6% (11/43) vs. 18%(9/50) (P =0.375) and 2.3% (1/43) vs. 2.0% (1/50) (P =0.714) respectively, and there were no significant difference between the two groups. Conclusions Primary resection and anastomosis without intraoperative colonic irrigation (decompression by manual defecation) compares favorably with traditional left-sided colectomy in safety and efficiency for left colonic cancer with obstruction.

Application of low-dose glucocorticoids In septic shock / 中国综合临床

Objective To study the role of low-dose glucocorticoids in improving prognosis and adjusting septic shock. Methods A total of 46 patients with a confirmed diagnosis of septic shock were retrospaetivley analyzed. 24 patients without glucocorticoids treatment were taken as control group; 22 patients with glucocorticoids as therapy group (n = 22). The two group received standard treatment for septic shock. Results The percentage of shock reversal on day 7 was higher in therapy group than that in control group (P <0.05). However,there were notstatistical significances in the duration of mechanical ventilation, the length of ICU stay, the incidence of multiple or-gan dysfunction syndrome (MODS) and mortality between the two groups (P > 0.05). Conclusion Low-dose glucocorticoids can effectively accelerate refractory septic shock reversal and vasopreasor withdrawal. This seems to be related to the reduced production of CRP but the beneficial effects of low-dose steroids regimens on long-term outcome have not yet be determined.

The pathological role of placenta growth factor / 国际外科学杂志

Angiogenesis is an important step during the occuring, development and metabsis of tumor which is regulated by some factors. PLGF is one of the VEGF family. It is homologous with VEGF-A, VEC,-FR-1 is its receptor. Although it expresses weakly during physiology. PLGF is an important pathologic angio-genesis factor at the condition such as anoxia, truma or tumor. Becanse its expression becomes strong at path-ologic cyophoria and many kinds of tumors, PLGF has a good value in clinic reasereh.

Clinical characteristics and treatment of severe hyperlipidemic pancreatitis / 中华全科医师杂志

Objective To summarize clinical characteristics and experiences in treatment of severe hyperlipidemic pancreatitis (SHLP). Methods A retrospective analysis for 22 cases of SHLP and 91 cases of severe acute biliary pancreatitis (SABP) hospitalized during January 1, 2000 to December 31, 2006 was carried out to compare their clinical characteristics and treatment outcomes. Results Activities of serum and urine amylase in SHLP patients at admission were (715 ± 99) and (382 ± 56) U/L, respectively, significantly lower than those in SABP patients (1551 ± 107) and (773 ± 66) U/L, respectively (P < 0.01). About 55% (12/22) of SHLP patients had pulmonary infection, 36% (8/22) with circulatory failure, 41% (9/22) with respiratory failure and 23 % (5/22) with renal failure, all significantly higher than those in SABP patients SABP [32% (29/91), 14% (13/91), 7% (6/91) and 5% (5/91), respectively, P < 0.01]. Two died of SHLP and 11 of SABP, respectively. Conclusions In diagnosis of SHLP, it should be noticed that no remarkable elevation of activities in serum and urine amylase usually, so during the course of treatment for SHLP, it is important to prevent and treat multi-organ failure, respiratory failure and renal failure in an active way.

Effect of low-dose glucocorticoids in septic shock / 中华急诊医学杂志

Objective To study retrospectively the effects of low-dose glucocorticoids in outcomeof septic shock.Method The present stray was carried out by analysis of septic shock patients treated with norepinephrine or dopamine.A total of 46 patients with a confirmed diagnosis of septic shock admitted from January 2000 to October 2006 were divided into two groups:(1)ghcocorticoids treatment group(n=22),treated with glucocorticoids in addition to conventional treatment from November 2002 to October 2006;(2)conlrol group(n =24),only treated with routine treatment from January 2000 to October 2002.The differences in outcome were compared between the two groups.Results The duration of of vasopressor support was significantly shorter in treatment group com0~ed with control group.The percentage of shock reversal at 7 days was higher in treatment group than that in control group(72.73%vs.41.67%,P=0.034).Furthermore,a reduction in C-reactive protein(CRP)indicated inhibition of inflammatory response due to the effect of glucocorticoids in treatment group within 48-72 hours from admission to ICU(20.05±4.06 mg/dl vs.23.55±4.93 mg/dl,P=0.015).Therefore,APACHE Ⅱ score on 3rd day was significantly lower in treatment group than that in control group(16.76±4.87 vs.21.45±4.02,P=0.001).However,there were no statistical signifieances in the duration of mechanical ventilation,the length of ICU stay,the incidence of multiple organ dysfunction syndrome(MODS)and hospital-mortality between the two groups(P＞0.05).Conclusions Tmatmeut with low-dose gheocorticoids could effectively accelerate the recovery from refractory septic shock and the early withdrawal of vasopressor.It seems to be associated with the reduced production of CRP,suggesting the effects of low-dose glucocorticoids on both stabilization of hemodynamics and inhibition of inflammatory response.The beneficial effects of low-dose steroids regimens on long-term outconm of patients with septic shock have not determined.

Effect of pneumoperitoneum on the liver blood flow in cirrhotic rats / 中华外科杂志

<p><b>OBJECTIVE</b>To determine the effect of pneumoperitoneum on liver indocyanine green (ICG) metabolism and the hepatic blood flow in normal and cirrhotic rats.</p><p><b>METHODS</b>Thirty male Wistar rats were randomized into five groups: normal anaesthesia group, normal laparotomy group, normal pneumoperitoneum group, cirrhosis + anaesthesia group, and cirrhosis + pneumoperitoneum group. Liver cirrhosis was induced in two groups by injecting carbon tetrachloride subcutaneously plus drinking 5% alcohol. ICG clearance tests were performed in all the rats.</p><p><b>RESULTS</b>The ICG level in the normal laparotomy group (0.662 micro g/ml) was higher than that in the normal anesthesia group (0.645 micro g/ml), but the difference was not significant (P > 0,05). The ICG level in the normal pneumoperitoneum group (0.967 micro g/ml) was significantly higher than that in the normal anesthesia and normal laparotomy groups (P < 0.05). The ICG levels in two cirrhotic groups were significantly higher than those in the other three groups (P < 0.05). The ICG level in the cirrhosis + pneumoperitoneum (1.348 micro g/ml) was significantly higher than that in the cirrhosis + anesthesia group (1.198 micro g/ml) (P < 0.05).</p><p><b>CONCLUSIONS</b>During laparoscopic surgery, pneumoperitoneum could decrease the liver ICG clearance rate and the hepatic blood flow, which are of clinical significance in determining the state of liver cirrhotic.</p>

Bile excretion of hepatocytes cultured in vitro / 中华外科杂志

<p><b>OBJECTIVE</b>To regain bile excretory function of hepatocytes cultured in vitro.</p><p><b>METHODS</b>Sandwich configuration was used to culture hepatocytes and the structure of bile canaliculi as well as the function of bile excretion was observed by immunocytochemistry and the test of FDA metabolism with a single collagen configuration as a control.</p><p><b>RESULTS</b>First, the formation of bile canaliculi was observed by immunocytochemistry. In sandwiched hepatocytes, the gradual development of bile canaliculi-like structures into an anastomotic network was observed. At 24 h after cell culture, the formation of bile canaliculi was observed. With time progressed, the bile canaliculi became more clear and the network was established at 120 h. In contrast, hepatocytes in single collagen configuration showed almost no network of bile canaliculi. Second, the ability for hepatocytes to internalize, metabolize and excrete compounds into bile was indicated by FDA metabolized in the hepatocytes. In sandwiched hepatocytes, the bile excretory function was shown at 96 h, but in single collagen system, no bile excretion was observed.</p><p><b>CONCLUSION</b>Cultured hepatocytes are able to regain bile excretion in a given certain condition. Sandwich-cultured hepatocytes can reestablish bile canalicular structure and regain bile excretory function.</p>

Dendritic cell induced cytotoxic lymph cells for the therapy of nude mouse transplanted tumor by pancreas cancer cell line Bxpc-3 / 中国普通外科杂志

Objective To study the antitumor effect of dendritic cell(DC) induced cytotoxic T lymphocyte (CTL). Method CTL induced by DC extracorporeally, were co-cultured with Bxpc-3 cells, CTL activity was observed by counting the killing of Bxpc-3 cells in vitro. Nude mice with Bxpc-3 cell transplant tumors were treated by injection of CTL on the edge of tumors, and kinetics of tumor growth was recorded, RT-PCR-ELISA was used to determine the telomerase of transplant tumor. Result CTL activity was 71.6%. Thirty-one days after transplantation tumor size and telomerase activity were not statistically different among therapy group and control group, whereas after fifty-five days tumor size (38?6)mm 2 , and telomerase activity (1.33?0.03) in CTL group were statistically different from that of ( 74? 33)mm 2 and (4.16?0.32) in control group. ConclusionDC induced CTLs suppress the experimental pancreatic tumor growth, providing an evidence for clinical immunotherapy of pancreatic cancer.

The Influence of Ascites in Severe Acute Pancreatitis (SAP) on the Viability and Function of Peritoneal Macrophages / 中国医师杂志

Objective To observe the influence of ascites in severe acute pancreatitis (SAP) on the function and viability of peritoneal macrophages in order to investigate the role of peritoneal macrophages in pathophysiological alteration and secondary pancreatic infection in SAP. Methods After the ascites of SAP models treated peritoneal macrophages for 1,3,6,12 and 24 hours in vitro, neutral red phagocytosis, cell viability and TNF secretion of peritoneal macrophages were determined respectively. Results The phagocytosis, cell viability and TNF secretion of macrophage all decreased with the treating time prolonged in the tests. Conclusions The ascites of SAP decreased the phagocytosis, viability and TNF secretion of peritoneal macrophages, and was one of the factors to promote secondary pancreatic and peripancreatic infection as well as bacterial translocation of gut.

Functional study of hepatocytes cultured in sandwich configuration / 中国普通外科杂志

Objective To develop a new culture system in which hepatocytes can restore in-vivo like function. Methods Sandwich configuration was used for the culture of hepatocytes, and protein synthesis as well as P 450-b ,albumin mRNA expression by in situ hybridization was studied. ResultsStable and gradually increasing protein synthesis and high level of P 450-b , albumin mRNA expression were observed. In contrast, protein secretion of hepatocytes cultured in conventional single collagen culture system was low and decreased until approximately zero seven days after, and mRNA expression of P 450-b ,albumin was low. Conclusions Sandwich configuration in which cell polarity of hepatocytes is reestablished like in vivo situation.

The prophylaxis and treatment of pancreatic infection in severe acute pancreatitis / 中国普通外科杂志

Objective To explore the prophyl axis and the timing of operation for pancreatic infection in patients with sever e acute pancreatitis(SAP).Methods 2 23 patients with SAP were treated in ICU from 1990 to 1999. The measures adopted against pancreatic infection included fluid resuscitation, nutritional support, antibiotics and prevention of hypoxemia, hypoperfusion and gut barrier dysf unction etc. Indication for operation in SAP was early pancreatic infection from 1990 to 1994. From 1995 to 1999, drainage of pancreatic abscess or localized infection with debridement of necrotic tissues was adopted. Results 23 (10.3%) patients received operation due t o pancreatic infection. The morbidity rate (8.7%) of pancreatic infection betwe en 1995 to 1999 was lower than that (12.4%) between 1990 to 1994. The postoper ative mortality rate (8%) of pancreatic abscess or localized infection was lower than that (50%) of early pancreatic infection. Co nclusion Comprehensive prophylaxis of pancreatic infection a nd delayed operation for pancreatic abscess or localized infection are effective treatment of SAP.