Researches On Surgical Intervention For Severe Acute Pancreatitis

ObjectiveTo observe and explore the procedure and effect of surgical intervention for severe acute pancreatitis(SAP)and compare surgical intervention with conservative treatment in the treatment method,indications,timing of intervention.Furthermore to evaluate a relevance and feasibility of surgical intervention in severe pancreatitis patients in Suzhou area.Method A retrospective analysis was done on 58 patients suffered from SAP between August 2009 and December 2013 in the first affiliated hospital of Soochow University and Suzhou Kowloon Hospital.According to the method of treatment these patients were divided into different groups: surgical intervention and conservative treatment group.Which take the 21 patients(36.2%)were in surgical intervention group,including 6 open surgery cases and 10 laparoscopic surgery cases and 5 endoscopic intervention cases,the other 37 cases(63.8%)did not receive surgical intervention.Analysis data of the two groups including sex,clinical characteristics of age,Ranson score,APACH ? score,CTSI and other data,as well as a variety of common incidence of complications and mortality and cure rate was also calculated.Further more,the subgroup analysis of time for surgical intervention was conducted.In addition,patients was divided into two groups according to APACHE?scores and underwent subgroup analysis.Result1.The overall mortality rate was 17.2%(10/58),conservative treatment group was 21.6%(8/37)and surgical intervention group was 9.5%(2/21).The cure rate of surgical intervention group was significantly higher than the conservative treatment group(78.4 % vs90.5%,P = 0.028).2.The incidence of complications in surgical intervention group was significantly less than conservative treatment group.In the surgical intervention group there were a little more complications cases in open surgery group than in the laparoscopic group and in the endoscopic group.l3.Timing of surgical intervention: six cases accept open surgery(10.3%): including one case of pancreatic capsule cut loose pancreatic bed plus peripancreatic peritoneal drainage,peritoneal lavage,the surgery time was 3 days after admission;two cases of pancreatic capsule incision,loose pancreatic bed plus pancreatic necrotic tissue,the operation time is 10 days after admission;one case of pancreatic capsule cut loose pancreatic bed plus and biliary drainage,the operative time was 7 days after admission;one case of pancreatic capsule cut loose plus pancreatic bed biliary drainage and cholecystectomy,the operation time is 15 days after admission;one case of involving the joint while the latter uses the peritoneum after lumbar peritoneal drainage,surgery time was 9 days after admission;three cases accept the sphincter of Oddi and place cut stone stent,surgery time is 1-2 days after admission,placement ENBD two cases,surgery time is 1-2 days after admission;10 cases of pancreatic necrotic tissue removal and laparoscopic peritoneal drainage,surgical time 3-12 days.4.The difference group scores of Ranson score and APACH icant.servative treagroup was not statistically significant.CTSI(CT degree of risk coefficient)values in the conservative treatment group was 5.3 ± 1.4.In the surgical intervention group in the open surgery group score value of 7.5 ± 1.5.Values in the laparoscopic group was 7.2 ± 1.5.Values in the endoscopic treatment group was 7.9 ± 1.7.The p value was 0.037 p <0.05.The difference is statistically significant..5.In the subgroup analysis of time for surgical intervention,early and middle group have less complications(p=0.035,p=0.029);and early group has the lower mortality(p=0.000).however,the average hospitalization days in the middle group is statistically shorter than the other two groups.6.Among the patients with lower APACHE? score(?12 points),the group received surgical intervention has more complications(p=0.035).But the mortality showed no difference between surgical and conservative group.Among the patients with higher APACHE? score(>12 points),the surgical group has lower complications(p=0.026)and mortality(p=0.021).No difference existed in hospitalization days.Conclusion: 1.Surgical intervention is an important complement to the treatment of SAP.2,early surgical in obstructive gallstone pancreatitis treatment has been gradually established.Endoscopic treatment of obstructive gallstone pancreatitis is an effective method,although the implementation of endoscopic therapy in these cases had certain risks and complications,the risks and trauma were much less complications.3,laparoscopic surgery continually be used extensively because of its complications was minimum.4,For SAP patients with lower APACHE?scores,surgical intervention should be cautious.However,for patients with higher APACHE ?scores,we may take prompt surgical intervention,especially within 7 days.but their practical conditions also should be taken into account.