Effects And Basic Analysis Of Different Drainage Modalities On Long-Term Pancreatic Function And Quality Of Life In Patients With Infected Pancreatic Necrosis

There were about 5-10%of acute pancreatitis(AP)patients with pancreatic parenchymal necrosis or pancreatic tissue necrosis.And Patients who had huge and widespread necrosis were prone to form infected pancreatic necrosis(IPN).According to the recent literature,IPN accounted for 80%of the total number of deaths in AP.And patients who had early multiple organ failure with IPN got higher mortality.Timely removal of the infected tissue can prevent the continued infusion of toxins,and effectively curb the persistent infection caused by IPN.Presently the treatment of IPN gradually diversified,but the traditional open necrosectomy(ON)and minimally invasive drainage(MID)were also the main treatment technique.ON need to meet the laparotomy indications and to avoid laparotomy contraindications,and have a great impact on the patients.However,MID was affected by liquefaction and distribution of pancreatic necrosis.At the present time,most study focuses on how to improve the treatment of IPN with various drainage methods and reduce the occurrence of complications.And with the progress of diagnosis and treatment technology and the change of treatment concept,IPN mortality dropped.And for the alive out-hospital acute pancreatic patients,more attention were given to long-term pancreatic function and quality of life.The incidence of new diabetes were high for the damage pancreas result from pancreatitis.So the discharged patients need for regular follow-up to detected blood glucose levels,and according to that treatment were given.And little literature focus on the quality of life of the cured IPN patients.In our study,the incidence of new on-set diabetes mellitus,the incidence of pancreatic exocrine insufficiency and the quality of life of the two groups of non-diabetic patients were investigated by randomized follow-up of patients with IPN treated via two main drainage methods.And basic analysis were done for different drainage modalities on long-term quality of life and pancreatic function in patients with IPN,which included pancreatic function biochemical indicators and existing complications.This thesis could be divided into two parts:PART1:Effects of different drainage modalities on pancreatic function and long-term quality of life in IPN patientsObjective:To explore the effects of different drainage modalities on pancreatic function and long-term quality of life in IPN patients.Methods:From 2001 to 2015 in Jinling Hospital of Nanjing University 124 IPN patients who were treated either by the open necrosectomy(ON)or by minimally invasive drainage(MID)were randomly collected.Pancreatic exocrine dysfunction was measured by fecal elastase-1,and quality of life was assessed by SF-36 scale.Pancreatic endocrine function was determined by fasting plasma glucose,glycosylated hemoglobin and 2-hour postprandial blood glucose.The basic information of the patients during hospitalization,the details of the intervene methods,and the relevant information of the patients after discharge were collected.Results:The 101 cases of IPN patients were finally included in the study,40 patients underwent ON(direct ON were 23 cases and indirect ON were 17 cases),and 61 patients received MID.The average time of follow-up was 42 months.There were 26(65.0%)males in the ON group and 40(65.5%)males in MID.The mean age of the two groups was respectively 48.65 ± 1.87 years and 49.16 ± 1.74 years.There were no statistically significant differences in alcohol consumption and family history of diabetes between the two groups.There was no significant difference between the two groups in etiology,pancreatitis classification,Balthazar score and APACHE II.The proportion of new-onset diabetics in the MID group was significantly lower than that in the ON group(33%<51%,P<0.048),and in subgroup analysis(P=0.007).There was no significant difference in pancreatic exocrine function.The quality of life in MID was significantly better than that in the ON group(P = 0.005),which was in the aspect of general health(P = 0.003),vitality(P-0.035)social function(P = 0.042),Role-Emotional(P=0.034)and mental health(P = 0.026)Conclusion:In the average time of follow-up was 42 months,compared with the open necrosectomy group,patients received minimally invasive drainage had lower proportion of new-onset diabetics and got better quality of life.PART2:Basic analyses of effects of different drainage modalities on pancreatic function and long-term quality of life in IPN patientsObjective:Make basic analyses of the effect of different drainage modalities on pancreatic function and quality of life and in IPN patients.Methods:From 2001 to 2015 in Jinling Hospital of Nanjing University 124 IPN patients who were treated either by the open necrosectomy(ON)or by minimally invasive drainage(MID)were randomly extracted.Pancreatic endocrine function was analyzed by fasting insulin,fasting C-peptide,fasting glucagon,2h insulin,2hC peptide,2h glucagon.Insulin resistance was assessed by insulin resistance index(HOMA-IR).Complications of SAP in the follow-up time were collected for further analysis.Results:The 101 cases of IPN patients were comprised in the study,included 40 patients underwent ON and 61 patients received MID.The average time of follow-up was 42 months.The percentage of high fasting insulin in the ON group was larger than that in the MID group(40%>20%,P = 0.026).In the subgroup the patients in the directed ON group were higher than those in the indirect ON group(43%>12%,P=0.003).In the case of insulin resistance,the proportion of insulin resistance in ON group was higher than that of the MID group(32%>10%,P=0.004).In the subgroup,the glucagon of patients in the ON group were higher than those in the MID group(48.07 ± 4.68>36.87 ± 2.85,P=0.043).On the time of follow-up,there was no significant difference between the two groups in gastrointestinal fistula,pancreatic pseudocyst,portal vein thrombosis and diarrhea.But there were significant differences in incisional hernia(9>0,P = 0.000).Conclusion:In this study,the lower incidence of new-onset diabetes mellitus in the minimally invasive group may be associated with less insulin resistance,and higher quality of life may be relevant to incisional hernia.