Impact of timing of abdominal paracentesis drainage on treatment outcomes in patients with severe acute pancreatitis / 中华肝胆外科杂志

ABSTRACT

Objective To study the impact of early abdominal paracentesis drainage (APD) on the clinical course in patients with severe acute pancreatitis and massive peritoneal effusion.Methods From January 2012 to January 2017,107 patients with severe acute pancreatitis treated at the Chengdu Military General Hospital were retrospective studied.According to whether the patients underwent abdominal paracentesis drainage within a week of hospital admission,they were divided into the APD group (n=66) and the Non-APD group (n=41).The APD group was further subgrouped into the 0-2 d (within 48 h),3-5 d and 6 -7 d subgroups.The mortality rates,progression rates,length of stay,cost of stay,organ failure rates and inflammatory state of each subgroup of the APD were statistically analyzed and compared.Results 22 patients in the Non-APD group progressed in four weeks to require percutaneous catheter drainage (PCD).The rate of progression was 53.7％,and the mortality rate was 22％.In the APD group,21 patients underwent PCD treatment within 4 weeks.The rate of progression was 31.8％ and the mortality rate was 9.1％.In the APD group,the progression rate for the patients in the 0-2 d subgroup was 6.9％,and the in-hospital mortality rate was O.When compared with the other subgroups,the 0 to 2 d subgroup of patients had significantly lower progression and in-hospital mortality rates,lower hospitalization duration and hospitalization costs.These patients at 1 week after hospitalization also had significantly better inflammatory indexes,less incidence of organ failure and better disease severity scores (P＜0.05).Conclusions The results confirmed the effectiveness of APD in treating patients with severe acute pancreatitis with significant peritoneal effusion.Puncture treatment within 48 hours significantly improved prognosis of patients.The best time window of APD treatment for patients with severe acute pancreatitis with massive abdominal fluid is within 48 hours of hospitalization.