Namhun Jong, S. Rim, Hye-Song Kim, Chung-Sa Ji, Hakchol Ri, Jong-Nam Kang
{"title":"超声引导下经皮导管引流在感染性胰腺坏死治疗中的作用","authors":"Namhun Jong, S. Rim, Hye-Song Kim, Chung-Sa Ji, Hakchol Ri, Jong-Nam Kang","doi":"10.26502/aimr.0013","DOIUrl":null,"url":null,"abstract":"Background: Percutaneous catheter drainage has been widely accepted in infected necrotizing pancreatitis. Aims: We evaluated clinical safety and efficacy of ultrasound-guided percutaneous catheter drainage in patients with infected pancreatic necrosis. Subjects: Our prospective study included 44 patients who developed infection of peri/pancreatic necrosis. Of these patients, 25 cases received ultrasound-guided PCD study group) whereas 21 cases underwent surgery (control group). Intervention: On admission all patients were treated with fluid therapy, nutritional support, antibiotics, gastrointestinal decompression and analgesics. Ultrasound-guided PCD or surgery were performed in patients who suspected infection of necrotic collection. Conversion to surgery were considered in patients who failed to PCD. Clinical outcomes: primary outcomes were changes in laboratory parameters before and after treatment, recovery days of inflammatory parameters (WBC, CRP). Secondary outcomes were the incidence of complication, mortality and hospital stay. Results: In the study group PCD period was 30 (median) days (9-91, range). PCD was unsuccessful in 9 (36.0%) patients, who required eventually cross over to necrosectomy. All laboratory parameters (WBC, CRP, serum amylase, blood glucose, serum calcium) were improved after therapy compared to before therapy in both groups (p<0.05). The post treatment comparison showed the level of WBC, CRP, serum amylase and blood glucose in the study group were significantly lower than those in the control group (p<0.05). In PCD group recovery days of WBC, CRP was significantly decreased compared to control group (p<0.05). In study group incidence of new-onset organ failure, intra-abdominal bleeding and incisional hernia significantly reduced than those in the control group (p<0.05). Finally, the mortality rate in the study group was lower than control group and study group had shorter hospital stays compared to control group (p<0.05). Conclusion: Ultrasound-guided PCD can reduce the need of surgical treatment and step-up approach (PCD followed by surgery) may decrease mortality than primary necrosectomy by minimizing pancreatic injury.","PeriodicalId":8282,"journal":{"name":"Archives of Internal Medicine Research","volume":"254 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"Role of Ultrasound-Guided Percutaneous Catheter Drainage in the Management of Infected Pancreatic Necrosis\",\"authors\":\"Namhun Jong, S. Rim, Hye-Song Kim, Chung-Sa Ji, Hakchol Ri, Jong-Nam Kang\",\"doi\":\"10.26502/aimr.0013\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: Percutaneous catheter drainage has been widely accepted in infected necrotizing pancreatitis. Aims: We evaluated clinical safety and efficacy of ultrasound-guided percutaneous catheter drainage in patients with infected pancreatic necrosis. Subjects: Our prospective study included 44 patients who developed infection of peri/pancreatic necrosis. Of these patients, 25 cases received ultrasound-guided PCD study group) whereas 21 cases underwent surgery (control group). Intervention: On admission all patients were treated with fluid therapy, nutritional support, antibiotics, gastrointestinal decompression and analgesics. Ultrasound-guided PCD or surgery were performed in patients who suspected infection of necrotic collection. Conversion to surgery were considered in patients who failed to PCD. Clinical outcomes: primary outcomes were changes in laboratory parameters before and after treatment, recovery days of inflammatory parameters (WBC, CRP). Secondary outcomes were the incidence of complication, mortality and hospital stay. Results: In the study group PCD period was 30 (median) days (9-91, range). PCD was unsuccessful in 9 (36.0%) patients, who required eventually cross over to necrosectomy. All laboratory parameters (WBC, CRP, serum amylase, blood glucose, serum calcium) were improved after therapy compared to before therapy in both groups (p<0.05). The post treatment comparison showed the level of WBC, CRP, serum amylase and blood glucose in the study group were significantly lower than those in the control group (p<0.05). In PCD group recovery days of WBC, CRP was significantly decreased compared to control group (p<0.05). In study group incidence of new-onset organ failure, intra-abdominal bleeding and incisional hernia significantly reduced than those in the control group (p<0.05). Finally, the mortality rate in the study group was lower than control group and study group had shorter hospital stays compared to control group (p<0.05). Conclusion: Ultrasound-guided PCD can reduce the need of surgical treatment and step-up approach (PCD followed by surgery) may decrease mortality than primary necrosectomy by minimizing pancreatic injury.\",\"PeriodicalId\":8282,\"journal\":{\"name\":\"Archives of Internal Medicine Research\",\"volume\":\"254 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2019-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Internal Medicine Research\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.26502/aimr.0013\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Internal Medicine Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.26502/aimr.0013","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Role of Ultrasound-Guided Percutaneous Catheter Drainage in the Management of Infected Pancreatic Necrosis
Background: Percutaneous catheter drainage has been widely accepted in infected necrotizing pancreatitis. Aims: We evaluated clinical safety and efficacy of ultrasound-guided percutaneous catheter drainage in patients with infected pancreatic necrosis. Subjects: Our prospective study included 44 patients who developed infection of peri/pancreatic necrosis. Of these patients, 25 cases received ultrasound-guided PCD study group) whereas 21 cases underwent surgery (control group). Intervention: On admission all patients were treated with fluid therapy, nutritional support, antibiotics, gastrointestinal decompression and analgesics. Ultrasound-guided PCD or surgery were performed in patients who suspected infection of necrotic collection. Conversion to surgery were considered in patients who failed to PCD. Clinical outcomes: primary outcomes were changes in laboratory parameters before and after treatment, recovery days of inflammatory parameters (WBC, CRP). Secondary outcomes were the incidence of complication, mortality and hospital stay. Results: In the study group PCD period was 30 (median) days (9-91, range). PCD was unsuccessful in 9 (36.0%) patients, who required eventually cross over to necrosectomy. All laboratory parameters (WBC, CRP, serum amylase, blood glucose, serum calcium) were improved after therapy compared to before therapy in both groups (p<0.05). The post treatment comparison showed the level of WBC, CRP, serum amylase and blood glucose in the study group were significantly lower than those in the control group (p<0.05). In PCD group recovery days of WBC, CRP was significantly decreased compared to control group (p<0.05). In study group incidence of new-onset organ failure, intra-abdominal bleeding and incisional hernia significantly reduced than those in the control group (p<0.05). Finally, the mortality rate in the study group was lower than control group and study group had shorter hospital stays compared to control group (p<0.05). Conclusion: Ultrasound-guided PCD can reduce the need of surgical treatment and step-up approach (PCD followed by surgery) may decrease mortality than primary necrosectomy by minimizing pancreatic injury.