Study On Puncture Timing Of Abdominal Paracentesis Drainage In Early Stage Of Severe Acute Pancreatitis Patients

Objective: In the early stage of severe acute pancreatitis(SAP),about 30-50% of patients have a large number of pancreatitis-associated abdominal fluid(PAAF).Studies have shown that PAAF contains a large amount of toxic substances such as trypsinogen activator and trypsin,and participates in the Pancreatitis disease severity process.Obviously,PAAF is a harmful substance for the body of patients with severe acute pancreatitis.How to deal with PAAF has become an urgent problem to be solved.At the same time,domestic and foreign scholars have been discussing the issue of whether pancreatitis-associated abdominal fluid needs drainage through surgical intervention,and some consensus on the diagnosis and treatment of pancreatitis suggests that conservative treatment should be adopted within 4 weeks of SAP onset.Surgical invasive procedures should be Postponed to 4W.However,in many foreign research literatures,there is a high incidence of treatment with percutaneous catheter drainage in 4W of SAP onset.Our previous study found that For PAAF in the early stages of SAP disease,abdominal paracentesis drainage(APD)can effectively remove it,and APD does not increase the risk of complications such as infection,and the best time for early APD treatment has not been explored,so This article will explore the impact of APD puncture timing on the outcome of patients with severe acute pancreatitis(SAP)along with a large number of fluid collections.Methods: The data of SAP patients admitted in clinic were analyzed retrospectively.Taking the pancreatitis database of the general surgery center as the main data source,the patients with severe acute pancreatitis admitted from January 2012 to January 2017 were collected from general surgery center of the Chengdu Military General Hospital.Search methods: 1)acute pancreatitis,2)organ failure time ? 48 h,3)imaging within 1 week after admission indicates pelvic / peritoneal effusion ? 100 ml,4)18 years ? age ? 65 years,5)admission within 72 h of onset,and our hospital is the first unit of diagnosis.Exclusion: 1)laparotomy was performed for acute abdomen or for definite diagnosis;2)history of previous laparotomy,acute or chronic pancreatitis;3)Acute pancreatitis secondary to surgery or ERCP;4)Pancreatitis caused by malignant diseases.A total of 107 SAP patients were included in the study.They were divided into APD group(66 cases)and Non-APD group(41 cases)according to whether they performed abdominal paracentesis drainage within one week after admission.APD group was divided into three subgroups according to puncture time node: 0-2 days(within 48 h),3-5 days and 6-7 days,and related indexes of each group were collected.Statistical tools were used to analyze and compare the mortality,advanced rate,length of stay,hospitalization expenses,organ failure and inflammatory state of patients between the two groups and APD subgroups.Results: In the Non-APD group,22 patients received advanced percutaneous catheter drainage(PCD)within 4 weeks,with an advanced rate of 53.7 % and a fatality rate of 22.0 %.In APD group,21 patients received advanced PCD treatment within 4 weeks,with an advanced rate of 31.8 % and a fatality rate of 9.1 %.Compared with the non-APD group,the advanced rate in APD group decreased significantly within 4 weeks(p < 0.05),and there was no significant difference in hospital mortality between the two groups.(P>0.05).The APD group was significantly better than the control group in terms of length of stay / ICU,cost of stay,inflammatory index,organ failure and disease severity score after 1 week of admission(P<0.05).In the APD group,2 patients in the subgroup of 0~2 days underwent PCD treatment within 4 weeks,the advance rate was 6.9%,and the mortality rate during the hospitalization period was 0,in the subgroups of 3~5 days and 6~7 days,there were 7 patients and 12 patients underwent advanced PCD treatment within 4 weeks,with an advance rate of 33.3% and 75.0%,respectively.Compared with other subgroups and control groups,the patients in the 0-2-day subgroup not only decreased the advanced rate and mortality during hospitalization,but also significantly reduced the length of stay,ICU stay and hospitalization expenses,but also improved the inflammatory indexes such as IL-6 and IL-10,c-reactive protein,TNF-?,organ failure and disease severity score at the 1st week after hospitalization(p < 0.05).Conclusion: For patients with severe acute pancreatitis with obvious peritoneal effusion,abdominal paracentesis drainage is effective and safe,and puncture treatment within 48 hours of onset can significantly improve the prognosis of patients,and puncture drainage within 48 h is the best time window.