Clinical study of different surgical approaches in laparoscopic debridement for patients with infected pancreatic necrosis / 中华外科杂志

ABSTRACT

Objective@#To examine the indications and effects of different surgical approaches in laparoscopic debridement for patients with infected pancreatic necrosis(IPN).@*Methods@#The clinical data of 213 IPN patients treated by laparoscopic debridement at Department of General Surgery, Xuanwu Hospital, Capital Medical University from June 2012 to February 2019 were retrospectively analyzed.The therapeutic effects were summarized and analyzed according to different surgical approaches. There were 123 cases in retroperitoneal approach group, including 73 males and 50 females, aging of (51.3±12.4) years; 59 cases in omental sac approach group, including 32 males and 27 females, aging of (48.3±14.2) years; 23 cases in combined approach group, including 13 males and 10 females, aging of (54.3±19.7) years; 8 cases in digestive tract approach group, including 5 males and 3 females, aging of (50.2±12.5) years.@*Results@#The time from onset to operation in retro-peritoneal, omental sac, combined and digestive tract approach groups were (44.3±22.8), (47.3±24.3), (52.6±21.2), (51.2±30.1) days, respectively; the operation time was (52.3±26.4), (64.3±29.2), (82.8±24.7), (78.2±38.1) minutes respectively; the median bleeding volume was 18, 33, 42 and 30 ml, respectively; and the first time to eat after operation was (2.5±1.6), (3.8±1.8), (3.7±2.0), (8.4±3.9) days, respectively.The incidence of complications (Clavien-Dindo grade Ⅲ and above) was 10.6%(13/123), 10.2%(6/59), 17.4%(4/23), 1/8 and the mortality was 4.9%(6/123), 3.4%(2/59), 4.3%(1/23) and 0, respectively.The overall mortality of all patients was 4.2%(9/213). The levels of inflammatory factors were significantly lower in all groups 7 days after operation than before, and no patients was converted to open surgery.@*Conclusion@#Individualized selection of the optimal laparoscopic debridement approach of pancreatic necrosis plays an important role in improving the efficacy and prognosis of IPN patients.