Clinical Retrospective Study Of Treatment In Seventy-eight Cases Of Severe Acute Pancreatitis

Objective Comparative study for seventy-eight severe acute pancreatitis patients on following parameters,days in hospital,cost,days on antibiotics,numbers on antibiotics, blood amylase recovery time(normal range:20～120U/L),C-reactive protein(CRP) recovery time(normal range:0～10mg/L),computed tomography severity index(CTSI), Ranson score,incidence rate of sepsis,acute respiratory distress syndrome(ARDS), multiple organ dysfunction syndrome(MODS),we intend to evaluate the efficacy and safety of severe acute pancreatitis treated by conservative therapy,conventional surgery and ultrasound-guided percutaneous catheter drainage(PCD).Methods Seventy-eight cases with severe acute pancreatitis between January 2002 and September 2008 in the Second Affiliated Hospital of Zhejiang University School of Medicine were enrolled in this study according to CTSI,they were divided into three groups:49 cases in conservative treatment,17 cases in surgery and 12 cases in PCD therapy.Forty-five patients with CTSI≤8.0 received due to no significant fluid collection and local or systemic complications,however,one patient with CTSI 7.0 was performed surgery for acute obstructive jaundice caused by gallbladder disease while had no indication of endoscopic therapy.Twenty-eight cases with CTSI＞8.0 were radomly divided into two other groups for surgery or PCD therapy due to extensive fluid collection and severe complications,however,four patients with CTSI＞8.0 were treated with conservative treatment and unwilling to receive surgery or PCD therapy. PCD was performed in 12 patients whether there was extensive fluid,liquefaction and safe puncture site.And the technique was performed by experienced radiologists guided with ultrasound,and the whole procedures were performed sterilely.Seventeen patients were performed with surgery of debridement removal and drainage.Results There was significant difference observed with mortality rate between surgery and PCD group(P=0.039),conservative treatment and surgery group(P=0.028),days of serum CRP recovered time showed that significant difference between surgery and PCD group(P=0.037).Conclusions SAP patients with CTSI≤8.0 might choose conservative treatment due to no significant fluid collection and local or systemic complications,patients with CTSI＞8.0 might receive surgery or PCD therapy due to extensive fluid collection and severe complications.Early drainage with PCD therapy decreased amount of inflammatory mediators release and absorption of endotoxin,decrease incidence of sepsis or ARDS or other severe complications,decrease mortality rate and avoid emergency surgery to achieve minimally invasive approach.