| Background:Infectious pancreatic necrosis(IPN) was a serious local complication of severe acute pancreatitis(SAP), wiht high mortality. Early traditional surgery had been used less because of its severe postoperative infections, complications, trauma and high mortality. In recent years, with the development of technology and its annex endoscopic, it was possible to use minimally invasive therapeutic method for infected pancreatic necrosis, and a variety of minimally invasive techniquesclinical were applied in clinic, which such as percutaneous nephrolithotomy debridement, CT-guided percutaneous catheter drainage, laparoscopic debridement, through the stomach or duodenum endoscopic debridement, debridement after video-assisted coating, etc. But these techniques were complicated, with a lot of complications, and had been restricted in fact. Endoscopic ultrasonography(EUS) guided drainage was the latest minimally invasive endoscopic techniquesin for infectious pancreatic necrosis in the world at present, and only used in a few hospitals. But due to the short time, less the number of cases, the efficacy and safety of further study.The purpose of this study was to evaluate the clinic efficacy and safety for EUS-guided stent drainage by comparing patients’ hypothermias, inflammatory markers, imagings before and after treatment.ObjectiveTo explore the effect and safety of endoscopic ultrasonography guided(EUS-guided)stent implantation for puncture drainage of infected pancreatic necrosis.Methods20 cases of infected pancreatic necrosis patients admitted from Jan. 2013 to Jan. 2016 were collected. They were all treated with EUS-guided stent drainage.We investigated their hospital informations retrospectively. Analysis The clinic data such as body temperature, leukocyte count, C-reactive protein, procalcitonin, necrotic lesion size and complications and follow-up after hospital discharge.Results1. The general situation: there were 20 patients diagnosed wiht IPN, 11 males and 9 females. The average ages were 47.9 ± 17.8 years( range 18-80 years). All patients were treated by EUS-guided stenting drainage,in which 14 cases placed for double pigtail plastic stents and 6 cases for covered metal stents, meantime 12 cases were treated with ENBD.2. The clinical symptoms and signs: the ratios of the symptomsthe for IPN in first time: abdominal pain 85%(17/20), vomiting 75%(15/20), jaundice 35%(7/20), fever 30%( 6/20) and weight decreased 10%(2/20).3. Evaluation of the therapeutic effect: The percentage of patients whose body temperature returned to normal after 1day, 3 days, 7 days, 14 days of treatment were 45%, 55%,60% and 65% respectively. The values of white blood cell count, serum C-reactive protein, procalcitonin and other indicators were improved obviously. There were 13 patients that their tumors had shrunk more than two-fold in volume on the 7 days after operation, the effective rate was 65%(13/20). There were 16 patients that their tumors had shrunk more than two-fold in volume on the 14 days after operation, the effective rate was 80%(16/20). At latest follow-up, there were 12 patients that their tumors had shrunk more than two-fold in volume, the effective rate was 75%(12/20)., of which there are 7 cases of abscess disappeared, the cure rate was 43.8%(7/16).4. Results of complications: Postoperative bleeding in one case and the bleeding were stopped after endoscopic treatment without other complications.5. Results of follow-up: Twenty patients after discharge from hospital were follow-up studied, there were 12 patients that their clinical symptoms disappeared and necrotic lesions were absorbed, one’s necrotic lesions were reduced and the clinical symptoms and the qualities of life were improved significantly, to continue follow-up. What’s more, there were 3 patients died and 4 lost to follow-up. Conclusion1. It is curative effective to treat for pancreatic infection necrosis with puncture and drainage guided by endoscopic ultrasonography.2. It is safe to treat for pancreatic infection necrosis with puncture and drainage guided by endoscopic ultrasonography. |
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