Objective: To observe the outcomes of no necrotic cavity lavage after debridement and drainage in patients with infected pancreatic necrosis(IPN). Methods: From February 2014 to August 2017, there were 89 patients who were diagnosed as IPN undergoing minimally invasive surgery with no necrotic cavity lavage and large caliber-wide channel drainage in Department of General Surgery, Xuanwu Hospital, Capital Medical University. There were 57 male and 32 female patients aging of (49.5±14.4)years (ranging from 23 to 84 years). The body mass index of 89 patients was (25.4±3.8)kg/m(2) (ranging from 17.6 to 36.7 kg/m(2)). Among the 89 patients, 37 cases(41.6%) of biliary pancreatitis, 10 cases (11.2%) of alcoholic pancreatitis, 16 cases(18.0%) of hyperlipidemic pancreatitis, and 26 cases(29.2%) of other reasons. Results: Of 89 patients, IPN in 6 patients(6.7%) resolved using only percutaneous catheter drainage; another 83 patients underwent laparoscopic debridement(n=3, 3.4%) or video-assisted debridement(n=80, 89.9%). No patient was conversed to laparotomy. The average operation frequency and surgery time was (2.3±1.7) times and (56.5±31.7) minutes.The median bleeding volume and total length of stay was 10(0-600) ml and 34(6-172) days separately. The complication rate(Clavien-Dindo grade≥Ⅲ) was 9.0%(8/89) which involved mainly abdominal hemorrhage (5/8) and digestive tract fistula formation (3/8). The overall mortality rate was 6.7%(6/89). Among them, 3 cases died of abdominal infection, bacteremia and multiple organ failure, 2 cases died of pulmonary infection and bacteremia and 1 case died of fungal infection. Conclusion: No necrotic cavity lavage after debridement and drainage operation is considered effective and safe for IPN patients.
目的： 探讨感染性胰腺坏死清创引流术后脓腔不灌洗的治疗效果。 方法： 回顾性分析2014年2月至2017年8月于首都医科大学宣武医院普外科接受微创清创引流术且术后采用脓腔不灌洗及大口径－宽通道引流方式治疗的89例感染性胰腺坏死患者的治疗效果，评估该技术的有效性。男性57例，女性32例，年龄(49.5±14.4)岁(范围：23～84岁)。体重指数为(25.4±3.8)kg/m(2)(范围：17.6～36.7 kg/m(2))。病因：胆源性37例(41.6%)，酒精性10例(11.2%)，高脂血症性16例(18.0%)，其他26例(29.2%)。 结果： 89例患者中，6例(6.7%)接受经皮穿刺置管引流治疗后好转出院，80例(89.9%)接受视频辅助微创清创术，3例(3.4%)接受全腹腔镜微创清创术，无中转开腹患者。手术次数(2.3±1.7)次，手术时间(56.5±31.7)min，出血量10 ml(范围：0～600 ml)，总住院时间34 d(范围：6～172 d)。并发症(Clavien－Dindo Ⅲ级及以上)发生率为9.0%(8/89)，主要包括腹腔出血5例、消化道瘘3例。总体病死率为6.7%(6/89)，其中死于腹腔感染、菌血症和多器官功能衰竭3例，死于肺部感染及菌血症2例，死于真菌感染1例。 结论： 清创引流术后脓腔不灌洗可以较安全有效地治疗感染性胰腺坏死。.
Keywords: Bacterial infections; Infected pancreatic necrosis; Large caliber-wide channel drainage; No necrotic cavity lavage; Pancreatitis, acute necrotizing.