Clinical efficacy of minimal access retroperitoneal pancreatic necrosectomy for infected pancreatic necrosis / 中华消化外科杂志

ABSTRACT

Objective To investigate the clinical efficacy of minimal access retroperitoneal pancreatic necrosectomy (MARPN) for infected pancreatic necrosis (IPN).Methods The retrospective cohort study was conducted.The clinical data of 61 patients with IPN who were admitted to Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology between January 2014 and December 2017 were collected.There were 39 males and 22 females,aged 36-67 years,with a median age of 49 years.Of 61 patients,40 undergoing open surgery were allocated into open group,and 21 undergoing MARPN were allocated into MARPN group.All the patients underwent surgical treatments after standard non-surgical treatments according to the Guidelines for the diagnosis and treatment of severe acute pancreatitis (2014 edition).Observation indicators(1) intraoperative and postoperative situations;(2) follow-up.Follow-up using telephone interview or outpatient examination was performed to detect weight loss,pathoglycemia,steatorrhea,intestinal obstruction,and pancreatic portal hypertension for one year after surgery up to December 2017.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed using the t test.Count data were represented as absolute numbers or percentages,and comparison between groups was done using the chi-square test.Results (1) Intraoperative and postoperative situationsoperation time,time to out-of-bed activity,time to initial food intake,cases with reoperation,cases with postoperative multiple organ dysfunction syndrome (MODS),incidence rate of postoperative complications,mortality,time to drainage-tube removal,duration of hospital stay,and hospital expenses were (77±20)minutes,(13.0±3.6) days,(9.0±2.7)days,8,9,45.0％ (18/40),7.5％(3/40),(37.0±6.3)days,(49±8)days,(84 321±8 872)yuan in the open group,and (59± 20) minutes,(2.7±0.9) days,(1.9 ± 0.4) days,6,2,19.0％ (4/21),0,(21.0± 2.7) days,(39 ± 6) days,(58 594±3 576) yuan in the MARPN group,respectively,showing no significant difference in the cases with reoperation (x2=0.69,P＞0.05) but significant differences in the other indices between the two groups (t =4.24,9.61,15.34,x2=23.76,4.02,36.03,t=11.07,5.93,8.43,P＜0.05).There were 18 patients with postoperative complications in the open group,including 2 with digestive hemorrhage,3 with abdominal hemorrhage,9 with pancreatic leakage,and 4 with intestinal leakage.There were 4 patients with postoperative complications in the MARPN group,including 3 with pancreatic leakage,and 1 with intestinal leakage.Patients with complications were treated by endoscopy,interventional therapy,placement of jejunal nutrition tube,and ileum stoma.Three patients in the open group died,and all the patients in the MARPN group were cured.(2) Follow-up47 of 61 patients were followed up for one year,including 31 in the open group and 16 in the MARPN group.During the follow-up,weight loss,pathoglycemia,steatorrhea,intestinal obstruction,and pancreatic portal hypertension were detected in 4,11,5,4,5 patients of the open group and in 2,6,2,0,3 patients of the MARPN group,showing no statistically significant difference between the two groups (x2=0.18,0.02,0.01,0.03,0.90,P＞0.05).Conclusion MARPN for IPN is safe and reliable,with certain efficacy,which can effectively reduce incidence of postoperative complication,motality and shorten hospital stay.