中国实用外科杂志2017，Vol.37Issue(10)：1169-1172,4.DOI:10.19538/j.cjps.issn1005-2208.2017.10.25
危重型急性胰腺炎外科治疗策略分析(附46例报告)
Surgical treatment strategies for critical acute pancreatitis: A report of 46 patients
摘要
Abstract
Objective To summarize clinical course and treatment strategy for critical acute pancreatitis (CAP).Methods A retrospective analysis was carried out using clinical data sourced from a database of patients with CAP admitted to the Xiangya Hospital,Central South University from January 2011 to November 2016.Organ failure,pancreatic and peri-pancreatic culture,interventions and outcomes were highlighted in the article.Results Out of a total of 46 CAP patients,the most common cause was gallstones (n=21),followed by hyperlipidemia (n=14),alcohol (n=6),and idiopathic acute pancreatitis (AP)(n=5).The overall mortality was 43.5％ (20/46).Eight patients developed single organ failure and none of them died;38 patients developed multiple organ failure and 20 of them died by January 2017 (mortality,52.6％) (P＜0.05).There were 129 microbiological samples obtained from the necrotic tissue in 47 patients,60.0％ of which were MDRO infection (n=77).Escherichia coli (19.2％,10/52) was the predominant common pathogen,whereas Acinetobacter baumannii (22.1％,17/77) was the most frequent MDRO infection.The mortality rate in the MDRO infection group was higher than that in the sensitive organism infection group (50.0％ vs.0,P＜0.05).Step-up approach of percutaneous catheter drainage followed by necrosectomy was performed in 39 patients,and the mortality rate was 41.0％ (16/39).The mortality rate of step-down approach based on necrosectomy was 71.4％ (5/7).Conclusion The prognosis of CAP patients is directly related to multiple organ failure and MDRO infection.Step-up approach based on PCD can be the first choice for surgeons.关键词
危重型急性胰腺炎/感染性胰腺坏死/胰腺坏死组织清除术/经皮穿刺置管引流Key words
critical acute pancreatitis/infected pancreatic necrosis/debridement of pancreatic necrosis/percutaneous catheter drainage分类
医药卫生引用本文复制引用
王迪,申鼎成,周书毅,刘志勇,纪连栋,魏伟,黄耿文..危重型急性胰腺炎外科治疗策略分析(附46例报告)[J].中国实用外科杂志,2017,37(10):1169-1172,4.基金项目
中南大学湘雅医院管理研究基金项目(No.2016GL12) （No.2016GL12）
