Effect of the proactive percutaneous catheter drainage strategy in the treatment of acute pancreatitis with infected necrosis / 局解手术学杂志

ABSTRACT

Objective To investigate the effect of the proactive percutaneous catheter drainage(PCD)strategy in the treatment of acute pancreatitis(AP)complicated with necrotic infection.Methods A total of 70 patients with AP complicated with necrotic infection and trea-ted by PCD from January 2016 to November 2017 were prospectively enrolled.The patients were randomly divided into the routine group(n=35)and the modified group(n =35)according to the random number table method.The same indication and principle were performed performed during the first time PCD in both of the two groups.However,the subsequent treatment strategy was different between the two groups.The routine group was given a maximum of 1 adjustment of the drainage tube position or another catheterization.If the drainage effect was still poor,the necrosectomy would be taken through laparoscope,nephroscope or laparotomy directly.While the modified group was given frequent and early drain revision and upsizing of drains in case of lack of clinical improvement.The general data,the total number of PCD pro-cedures,the maximal final drain size,the duration between the first two times of PCD,the total drainage duration,the number of patients need for necrosectomy,the length of hospital stay after drainage,the number of patients need for new ICU admission,the number of patients need for readmission,complications and mortality were compared between the 2 groups.Results The total number of PCD procedures and the maxi-mal final drain size of the modified group was significantly higher than that of the routine group(P<0.05 or P<0.01).The duration be-tween the first two times of PCD in the modified group was significantly shorter than of the routine group(P<0.01).The ratio of patients need for necrosectomy and suffered new-onset multiple organ failure significantly decreased in the modified group,and the difference was sta-tistically significant(P<0.05).There was no significant difference between the two groups in total days of drainage,length of hospital stay after drainage,number of patients need for new ICU admission,number of patients need for readmission,complications and mortality.Conclu-sion The proactive PCD strategy of frequent and early drain revision and upsizing of drains for patients with acute infected necrotizing pan -creatitis when lack of clinical improvement can reduce the proportion of recurrent multiple organ failure and the need for necrosectomy,and it does not increase the risk of related complications.