Analysis Of Total Surgical Efficacy And Discussion Of Intervention Scheme For Severe Acute Pancreatitis

Objective: To analyze and summarize the course of disease and surgical intervention scheme of severe acute pancreatitis(severe acute pancreatitis,SAP)in Zunyi Medical University,and to provide reference for clinical work.Methods: The clinical data of(severe acute pancreatitis,SAP)patients with severe acute pancreatitis admitted to the Affiliated Hospital of Zunyi Medical University on June 30,2010.01.01 were analyzed retrospectively.According to the surgical intervention after admission,the patients were divided into three groups:(percutaneous catheter drainage,PCD group,(open pancreatic necrosectomy,OPN)group and PCD OPN group.The main results were as follows:(1)the general data,curative effect indexes(hospitalization days,hospitalization expenses,death cases)were compared between PCD group and OPN group,PCD OPN group and OPN group,respectively.(2)according to the time of surgical intervention,the PCD group was divided into early treatment group(within 1 week)and delayed treatment group(intervention time more than 1 week).The OPN group was divided into early treatment group(within 2 weeks of intervention)and delayed treatment group(intervention time greater than 2 weeks).(3)The cure and discharge were set as the outcome,and the signed discharge was included in the deleted data.The variables of univariate analysis(P < 0.05)in K-M test were included in multivariate COX survival analysis,and the factors affecting the curative effect of PCD,OPN and the timing and indication of PCD,OPN were analyzed.Results:(1)Compared with OPN group,PCD significantly reduced hospitalization days(23±15 vs 51±35,P < 0.01)and hospitalization expenses(6.47(6.21,8.89)vs 17.42(12.75,20.18),P < 0.01)in PCD group.It can also reduce(multiple organ failure,MOF)(5 cases(4%)vs 10 cases(12%),P < 0.05)and retroperitoneal compartment syndrome(Retroperitonea)in 5 cases(4%)with new multiple organ failure after operation.The risk of SAP patients(24 cases(19%)vs 28(33%),P <0.05)was reduced in 10(8%)and 10(8%)vs16(19%),P <0.05),and in the combination of wrap-and-necrotic(WON)(8(6%)vs 11(15%),P <0.05).(2)compared with OPN group,patients with transfer to OPN after PCD and patients with OPN alone were hospitalized for days,secondary infection,new peripancreatic fluid,new RCS,with pancreatic pseudocyst,abdominal or digestive tract bleeding and pancreatic fistula,compared with OPN group,the patients with OPN and OPN alone were hospitalized for days,secondary infection,new peripancreatic fluid,new RCS,with pancreatic pseudocyst,abdominal or digestive tract bleeding,pancreatic fistula,There was no significant difference in mortality rate(P=0.364;P=0.534;P=0.247;P=0.576;P=1.000;P=0.157;P=0.075;P=0.558;P=1.000;P=0.460).(3)in PCD group,if the CTSI score was greater than or equal to 7(χ2=16.598,P<0.01)or the surgical intervention time of PCD was more than 1 week(P < 0.01),there was a risk of increasing the hospitalization time.(4)patients in OPN group underwent surgical intervention within2 weeks(χ2=15.933,P < 0.01),complicated with infection before operation(χ2=11.729,P< 0.01),high CTSI score(χ2=13.761,P < 0.01),and peripancreatic effusion(χ2=15.574,P< 0.01).P < 0.01),there was a risk of increasing hospitalization time.Conclusion:(1)for patients with SAP,if the CTSI score is less than 7,PCD treatment can be considered in the early stage(within 1 week).In view of the serious condition(early complicated with severe infection before MOF,and large or multiple peripancreatic effusion),if the operator is sure to control the degree of peripheral organ injury during operation,it is suggested that PCD should also be actively treated.(2)if the clinical symptoms of the patients are not relieved or the condition is worse,it is suggested that the patients should pass through the acute phase of SAP and OPN treatment after 2 weeks.