Percutaneous catheter drainage and negative pressure irrigation for severe acute pancreatitis (SAP) patients with infective pancreatic necrosis / 中华胰腺病杂志

ABSTRACT

Objective To observe the clinical effectiveness of percutaneous catheter drainage ( PCD ) and PCD + negative pressure irrigation ( PCD + NPI ) for treatment of severe acute pancreatitis ( SAP ) patients with infective pancreatic necrosis (IPN).Methods Data of 71 IPN patients admitted from January 2010 to December 2011 were included and retrospectively analyzed.They were divided into two groups by the different treatment choicesPCD group (52 patients) and PCD + NPI group (19 patients).In PCD group,percutaneous pig-tail drainage catheter was inserted for intermittent IPN drainage,and in PCD + NPI group,negative pressure irrigation catheter was inserted for continuous IPN drainage.The indication for laparotomy surgery was no improvement after PCD or PCD + NPI for 3 days,or septic shock,abdominal cavity bleeding,digestive tract fistula occurred,the area of IPN decreased less than 1/2.Results The surgery rate of PCD +NPI group was 15.8％,which were significantly lower than that in PCD group (48.1％,P ＜0.05).7(36.8％ ) patients in PCD + NPI group received endoscopic drainage,which were significantly higher than that in PCD (0,P ＜0.05).The time interval between initial tube placement and operation in the PCD + NPI group was (22 ± 11 ) d,which were significantly longer than that in PCD group [ ( 10 ± 6 ) d,P ＜ 0.05 ].The difference of mean session and number of tube placement,number of laparotomy surgery,complications of laparotomy surgery in the two groups was not statistically significant.The mortality rate in the PCD + NPI group was 15.8％,which was not significantly higher than that in PCD group ( 13.5％ ).The ICU days,length of hospital stay and hospital costs in PCD + NPI group were lower than those in the PCD group,but the difference between the two groups was not statistically significant.Conclusions PCD + NPI can effectively reduce operation rate for patients with infective pancreatic necrosis.