Observation Of The Effect Of IPN Assisted By Laparoscopic-assisted Necrotic Tissue Removal Via Retroperitoneal Approach

Objective:To investigate the safety,effectiveness and feasibility of Laparoscopic-assisted necrotic tissue removal via retroperitoneal approach to treat severe acute pancreatitis with infected peripancreatic necrosis.In order to provide a basis for the selection of reasonable clinical treatment in the future.Methods:42 cases of severe acute pancreatitis with infected peripancreatic necrosis admitted to the general surgery department of Shanxi Dayi Hospital from June 2013 to June 2018 were collected,all patients met the inclusion and exclusion criteria,and were given routine basic treatment before operation.According to the different surgical methods,they were divided into minimally invasive surgery group(Laparoscopic-assisted necrotic tissue removal via retroperitoneal approach)and traditional surgery group(Traditional laparotomy for necrotic tissue removal approach),there were 19 patients in the minimally invasive surgery group and 23 patients in the traditional surgery group.The differences of operation time,postoperative hospitalization time,hospitalization cost,postoperative abnormal time of blood amylase,postoperative abnormal time of PCT,intraoperative blood loss,postoperative feeding time,complications(gastrointestinal fistula,abdominal bleeding),secondary operation,mortality and other indicators between the two groups were analyzed.Results:1.In the minimally invasive surgery group,the operation time was(92.89±4.47)min,postoperative hospitalization time was(26.26±4.48)d,postoperative abnormal time of blood amylase was(13.47±1.98)d,postoperative abnormal time of PCT was(13.11±1.60)d,intraoperative blood loss was(44.89±2.84)ml,and oral feeding time was(5.32±0.53)d.The operation time of patients in the traditional surgery group was(113.83±6.36)min,postoperative hospitalization time was(33.35±3.88)d,postoperative abnormal time of blood amylase was(17.00±2.22)d,postoperative abnormal time of PCT was(18.48±2.27)d,intraoperative blood loss was(61.96±2.02)ml,and oral feeding time was(6.96±0.76)d.The results showed that the patients in the minimally invasive surgery group had significant differences in operation time,postoperative hospitalization time,postoperative abnormal time of blood amylase,postoperative abnormal time of PCT,intraoperative blood loss and time of oral feeding compared with the patients in the traditional surgery group,and the differences were statistically significant(P < 0.05).2.In the minimally invasive surgery group,2 patients had digestive tract fistula,1had abdominal bleeding,3 had secondary surgery,1 had death,and the hospitalization cost was RMB(8.47±0.47)million.In the traditional surgery group,2 patients had digestive tract fistula,3 had abdominal bleeding,2 had secondary surgery,and 1 had death,and the hospitalization cost was RMB(8.44±0.39)million.The results showed that there was no significant difference between the minimally invasive surgery group and the traditional surgery group in complications(digestive tract fistula,abdominal bleeding),secondary surgery,mortality,and hospitalization costs(P > 0.05).Conclusions:The results of this study confirmed the high safety,effectiveness and feasibility of Laparoscopic-assisted necrotic tissue removal via retroperitoneal approach in patients with Severe acute pancreatitis with Infected peripancreatic necrosis.