The Foundation Of New Mode Of Minimally Invasive Drainage For Patients Of Severe Acute Pancreatitis With Infective Pancreatic Necrosis

Part:1:The clinical effectiveness and influence factors of percutaneous catheter drainage for patients of severe acute pancreatitis with infective pancreatic necrosisSection 1:The clinical effectiveness of percutaneous catheter drainage and laparotomy for patients with infective pancreatic necrosis.Objective:To compare the clinical effectiveness of percutaneous US-or CT-guided catheter drainage and laparotomy for patients with infective pancreatic necrosis.Methods:90 infective pancreatic necrosis patients admitted to the JinLing hospital from Jan 2008 to Dec 2009 were included in this retrograde study.They were divided into two groups by the different treatment choices.27 patients in the PCD group received percutaneous US-or CT-guided catheter drainage as first choice.After that a sump suction apparatus was applied for controlled drainage.If no improvement was achieved after 3 days,they will received operation soon.While patients in the laparotomy group received surgical drainage at the time when the diagnosis of infected pancreatic necrosis was confirmed.Continous drainage was also applied for these ones.Result:The PCD group had a significant low rate of reoperation(7.1%vs.14.3%,p<0.05)and postoperative residual absecesses(7.1%vs.28.6%,p<0.05).Furthermore,48.1%of patients in PCD group successfully avoid laparotomy.In the regard of complications,the PCD group presented lower incidence of both single organ dysfunction(7.4%vs.28.6%,p<0.05),intestinal fistula(7.4%vs.27.0%,p<0.05)and long-term complications(3.7%vs.22.2%,p<0.05).In addition,the PCD group costed less medical resources as evidenced by shorter ICU duration(21.2±9.7 vs.28.7±12.1,p<0.01),shorter hospital duration(48.2±12.5 vs.59.6±17.5,p<0.O5)and less expenditure(191762±5892 vs.341689±10854,p<0.05).Conclusion:Percutaenous catheter drainage could effectively lower the surgical rates and the rates of complications and reoperations in patients with infective pancreatic necrosis.Besides that,it could also reduce the cost of medical resources.Section 2:The clinical analysis of percutaneous catheter drainage for patients with infective pancreatic necrosisObjective:To learn the clinical effectiveness of percutaneous US-or CT-guided catheter drainage for patients with infective pancreatic necrosis and the possible influencing factors.Methods:34 infective pancreatic necrosis patients admitted to the Jinling hospital from Jan 2008 to Feb 2010 were included in this retrograde study.All of them received PCD percutaneous as the first choice for treatment.After that,they were divided into two groups according to different clinical effectiveness of PCD.The two groups were compared for demographics,systemic and local complications and clinical outcomes.Results:19 of the 34 patients were cured through PCD alone(55.9%).The two groups are comparable for most baseline and clinical characteristics like age,sex,etiology,interval to the onset of the disease,duration of mechanical ventilation and CRRT,the use of vasopressor agents,APAC' E II score and Balthazar's Cd score.Additionally,the number of catheter used for drainage and bacterial culture result were also similar between these two groups.Only the CT value and distribution range of infective pancreatic necrosis were different between them.The logistic regression analysis revealed similar results,too.Conclusion:The CT value and distribution range of infective pancreatic necrosis could significantly influence the success rate of PCD and should be serious considered before the treatment decision.Part 2:The innovation of minimally invasive drainage for patients of severe acute pancreatitis with infective pancreatic necrosisBackground:Nowadays,the minimally invasive drainage for IPN includes:transgastric endoscopic drainage,TED;percutaneous catheter drainage,PCD;video-assisted retroperitoneal debridement,VARD.However,either single technique of drainage or multiple techniques combined needs to be improved in treating IPN.Objective:To improve the existing techniques of drainage and explore more safe and effective related techniques in minimally invasive drainage.Methods:From the year of 2010,we have begun to do some research in minimally invasive drainage,including tools,materials,and protocols and so on.Results:We have developed some new minimally invasive drainage techniques for IPN,improved and invented some tools and materials,studied some operation procedures,including:(1)percutaneous catheter drainage;(2)continuous negative pressure irrigation;(3)endoscopic drainage;(4)open necrosectomy.Conclusion:New minimally invasive drainage techniques are more safe and effective than before,the tools,materials and procedures contained.Part 3:The foundation of new mode of minimally invasive drainage for patients of severe acute pancreatitis with infective pancreatic necrosisBackground:At present,the internationally popular mode of "Step-up"minimally invasive drainage have gotten some breakthrough in some aspects,but the evaluation index between steps and the indications for step-up are not scientific enough,which interferes advantages in technique to the maxima.We have established the new mode of minimally invasive drainage,which makes up for these disadvantages of the "Step-up".Objective:To observe the clinical effectiveness of our new mode of minimally invasive drainage in patients of SAP with IPN.Methods:625 patients of SAP were included in this prospective observation research,admitted to the intensive care unit(ICU)of the Institute of General Surgery,Jinling Hospital,from November 2010 to February 2013.According to the inclusive and exclusive criteria,125 patients of SAP with IPN got the treatment of our new mode of minimally invasive drainage.Results:125 patients of SAP with IPN,73 patients got cured by PCD only,7 patients by CNPI only,6 patients by PCD+CNPI,7 patients by PCD+CNPI+ED,18 patients by PCD+ON,6 patients by PCD+CNPI+ON,2 patients by PCD+CNPI+ON,3 patients by CNPI+ED,3 patients by CNPI+ON.29 patients got ON,with an ON rate of 23.2%.90 patients got cured by the first three steps,reducing an ON rate of 72%.14 patients died,with mortality of 11.2%,and mortality of 27.6%for ON patients.Conclusion:Compared to the "Step-up" mode,our new mode of minimally invasive drainage to treat patients of IPN,can be able to reduce the rate of ON and mortality obviously.Main conclusions of this research1.PCD is able to reduce the rate of ON and postoperative residual abscess effectively,so are the short-term and long-term complications.Mean ICU duration,mean hospital duration,mean hospital expense all decline remarkably.2.The mean CT value and distribution range of infective pancreatic necrosis could significantly influence the success rate of PCD,the more of the value,the higher of possibility of failure by PCD.Conversely,PCD is the first choice.3.Compared with the existing techniques of minimally invasive drainage,our new techniques are more safe and effective in many aspects,such as tools,materials,and procedures and so on.4.Compared to the "Step-up" mode,our new mode of minimally invasive drainage to treat patients of IPN,can be able to reduce the rate of ON and mortality obviously.