内镜清创术与外科清创术治疗胰腺坏死感染的回顾性研究

樊超强; 刘恩; 杨歆; 林辉; 景江建; 柏健鹰; 杨仕明; 赵晓晏; 杨学森

doi:10.16016/j.1000-5404.201612051

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内镜清创术与外科清创术治疗胰腺坏死感染的回顾性研究

临床医学 | 更新时间：2026-01-09

- 内镜清创术与外科清创术治疗胰腺坏死感染的回顾性研究
- Efficacy of endoscopic and surgical necrosectomy for infected pancreatic necrosis: a retrospective study of 68 cases
- 第三军医大学学报 2017年39卷第8期页码：807-812
- 作者机构：
- 作者简介：
- 基金信息：
  
  第三军医大学新桥医院临床科研项目(2014YLC15)
- DOI：10.16016/j.1000-5404.201612051
  中图分类号：
- 纸质出版：2017-04
- 稿件说明：
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樊超强, 刘恩, 杨歆, 等. 内镜清创术与外科清创术治疗胰腺坏死感染的回顾性研究[J]. 第三军医大学学报, 2017,39(8):807-812.

Chaoqiang Fan, En Liu, Xin Yang, et al. Efficacy of endoscopic and surgical necrosectomy for infected pancreatic necrosis: a retrospective study of 68 cases[J]. Journal of Third Military Medical University, 2017, 39(8): 807-812.
樊超强, 刘恩, 杨歆, 等. 内镜清创术与外科清创术治疗胰腺坏死感染的回顾性研究[J]. 第三军医大学学报, 2017,39(8):807-812. DOI： 10.16016/j.1000-5404.201612051.

Chaoqiang Fan, En Liu, Xin Yang, et al. Efficacy of endoscopic and surgical necrosectomy for infected pancreatic necrosis: a retrospective study of 68 cases[J]. Journal of Third Military Medical University, 2017, 39(8): 807-812. DOI： 10.16016/j.1000-5404.201612051.

摘要

Abstract

Objective

To evaluate the clinical efficacy of endoscopic and surgical necrosectomy in the treatment of infected pancreatic necrosis.

Methods

A retrospective study was conducted among 34 patients with infected pancreatic necrosis treated by endoscopic necrosectomy in the Endoscopy Center of Xinqiao Hospital from June 2009 to June 2016 and 34 patients treated by surgical necrosectomy in Southwest Hospital and Daping Hospital during the same period. The clinical characteristics and outcomes of the patients were compared between the 2 groups.

Results

The success rate of operation were 100% in both groups. The mortality rate was 8.82 % in the endoscopic group

significantly lower than that of the surgical group (41.18%

0.01). The endoscopic group also had an obviously lower incidence of complications than the surgical group [11.76% (4/34)

67.65% (23/34)

0.01

]

. Bleeding

organ failure and shock were the main complications

whose incidences were 2.94% (1/34)

0 (0/34) and 2.94% (1/34) in the endoscopic group

and 61.76% (21/34)

41.18% (14/34) and 47.06% (16/34) in the surgical group

respectively (

0.01). The recurrence rate was 8.82% in both groups. The patients in the endoscopic group had more times of operations (2.62

1.06 times

0.01)

longer length of hospital stay (83.5

54.2 d

0.05) and higher hospitalization cost (351 800

218 400 Yuan

0.01) than those in the surgical group.

Conclusion

Compared with conventional surgical treatment

endoscopic necrosectomy can reduce the mortality rate and lower the incidence of complications for treatment of infected pancreatic necrosis

but is associated with more times of operations

a longer of hospital stay and a higher hospitalization cost.

关键词

Keywords

references

王春友杨明《急性胰腺炎诊治指南 (2014)》解读--急性胰腺炎外科诊治现状与进展中国实用外科杂志 2015 35 1 8 10 10.7504/CJPS.ISSN1005-2208.2015.01.03 王春友, 杨明.《急性胰腺炎诊治指南 (2014)》解读--急性胰腺炎外科诊治现状与进展[J].中国实用外科杂志, 2015, 35(1): 8-10.DOI:10.7504/CJPS.ISSN1005-2208.2015.01.03.

Wang C Y Yang M Interpretation of guidelines for the diagnosis and treatment of acute pancreatitis (2014) —Present status and development actuality of treatment of acute pancreatitis Chinese Journals of Practical Medicine 2015 35 1 8 10 10.7504/CJPS.ISSN1005-2208.2015.01.03 Wang C Y, Yang M.Interpretation of guidelines for the diagnosis and treatment of acute pancreatitis (2014) —Present status and development actuality of treatment of acute pancreatitis[J].Chinese Journals of Practical Medicine, 2015, 35(1): 8-10.DOI: 10.7504/CJPS.ISSN1005-2208.2015.01.03.

Janneke V G Sandra V B Olaf J B Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study International Hepato-Pancreato-Biliary Association Inc 2016 18 49 56 10.1016/j.hpb.2015.07.003 Janneke V G, Sandra V B, Olaf J B, et al.Diagnostic strategy and timing of intervention in infected necrotizing pancreatitis: an international expert survey and case vignette study[J].International Hepato-Pancreato-Biliary Association Inc, 2016, 18: 49-56.DOI:10.1016/j.hpb.2015.07.003.

Walter B Fabio R Marcello B Necrotizing pancreatitis:A review of the interventions International Journal of Surg-ery 2016 28 S163 S171 10.1016/j.ijsu.2015.12.038 Walter B, Fabio R, Marcello B, et al.Necrotizing pancreatitis:A review of the interventions[J].International Journal of Surg-ery, 2016, 28: S163-S171.DOI: 10.1016/j.ijsu.2015.12.038.

De Waele J J . A step-up approach, or open necrosectomy for necrotizing pancreatitis [J ] . N Engl J Med , 2010 , 363 ( 13 ): 1286; author reply 1287 . DOI: 10.1056/NEJMc1005950 . De Waele J J.A step-up approach, or open necrosectomy for necrotizing pancreatitis[J].N Engl J Med, 2010, 363(13): 1286; author reply 1287. DOI: 10.1056/NEJMc1005950.

蔡守旺刘志伟董家鸿经皮肾镜治疗胰腺坏死感染技术要点中国实用外科杂志 2012 32 7 596 597 http://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201207037.htm 蔡守旺, 刘志伟, 董家鸿, 等.经皮肾镜治疗胰腺坏死感染技术要点[J].中国实用外科杂志, 2012, 32(7): 596-597.

Cai S W Liu Z W Dong J H Surgical points of percutaneous nephroscopy in treatment of pancreatic necrosis secondary infection Chinese Journals of Practical Medicine 2012 32 7 596 597 http://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201207037.htm Cai S W, Liu Z W, Dong J H, et al.Surgical points of percutaneous nephroscopy in treatment of pancreatic necrosis secondary infection[J].Chinese Journals of Practical Medicine, 2012, 32(7): 596-597.

陈燕李兆申杜奕奇急性胰腺炎局部并发症之胰腺坏死感染的治疗新进展中华胰腺病杂志 2015 15 1 66 70 10.3760/cma.j.issn.1674-1935,2015.01.021 陈燕, 李兆申, 杜奕奇.急性胰腺炎局部并发症之胰腺坏死感染的治疗新进展[J].中华胰腺病杂志, 2015, 15(1): 66-70.DOI: 10.3760/cma.j.issn.1674-1935,2015.01.021.

Chen Y Li Z S Du Y Q Progress in treatment for local complication of acute pancreatitis—pancreatic necrosis secondary infection Chinese Journal of Pancreatology 2015 15 1 66 70 10.3760/cma.j.issn.1674-1935,2015.01.021 Chen Y, Li Z S, Du Y Q.Progress in treatment for local complication of acute pancreatitis—pancreatic necrosis secondary infection[J].Chinese Journal of Pancreatology, 2015, 15 (1): 66-70.DOI:10.3760/cma.j.issn.1674-1935,2015.01.021.

Seifert H Wehrmann T Schmitt T Retroperitoneal endoscopic debridement for infected peripancreatic necrosis Lancet 2000 356 9230 653 655 10.1016/S0140-6736(00)02611-8 Seifert H, Wehrmann T, Schmitt T, et al.Retroperitoneal endoscopic debridement for infected peripancreatic necrosis[J].Lancet, 2000, 356(9230): 653-655.DOI:10.1016/S0140-6736(00)02611-8.

Carter C R McKay C J Imrie C W Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis: an initial experience Ann Surg 2000 232 2 175 180 10.1097/00000658-200008000-00004 Carter C R, McKay C J, Imrie C W.Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis: an initial experience[J].Ann Surg, 2000, 232(2): 175-180.DOI:10.1097/00000658-200008000-00004.

Tenner S Baillie J De Witt J American College of Gastroenterology Guidelines:management of acute pancreatitis Am J Gastroenterol 2013 108 1400 1415 10.1038/ajg.2013.218 Tenner S, Baillie J, De Witt J, et al.American College of Gastroenterology Guidelines:management of acute pancreatitis[J].Am J Gastroenterol, 2013, 108: 1400-1415.DOI:10.1038/ajg.2013.218.

中华医学会消化病学分会胰腺疾病学组中华胰腺病杂志编辑委员会中华消化杂志编辑委员会中国急性胰腺炎诊治指南 (2013年, 上海) 中华消化杂志 2013 33 4 217 222 10.3760/cma.j.issn.0254-1432.2013.04.001.Pancreatic 中华医学会消化病学分会胰腺疾病学组, 中华胰腺病杂志编辑委员会, 中华消化杂志编辑委员会.中国急性胰腺炎诊治指南 (2013年, 上海)[J].中华消化杂志, 2013, 33(4): 217-222.DOI:10.3760/cma.j.issn.0254-1432.2013.04.001.Pancreatic

Disease Subgroup of Digestive Disease Branch from Chinese Medical Association Editorial Board of Chinese Pancreatic Diseases Editorial Board of Chinese Journal of Digestive Diseases Guidelines for Diagnosis and Treatment of Acute Pancreatitis in China (2013, Shanghai) Chinese Journal of Digestion 2013 33 4 217 222 10.3760/cma.j.issn.0254-1432.2013.04.001 Disease Subgroup of Digestive Disease Branch from Chinese Medical Association, Editorial Board of Chinese Pancreatic Diseases, Editorial Board of Chinese Journal of Digestive Diseases.Guidelines for Diagnosis and Treatment of Acute Pancreatitis in China (2013, Shanghai)[J].Chinese Journal of Digestion, 2013, 33(4): 217-222.DOI:10.3760/cma.j.issn.0254-1432.2013.04.001.

Olaf J B Hjalmar C S Sandra B G Endoscopic Transgastric vs Surgical Necrosectomy for Infected Necrotizing Pancreatitis JAMA 2012 10 307 1053 1061 http://paper.medlive.cn/literature/187776 Olaf J B, Hjalmar C S, Sandra B G, et al.Endoscopic Transgastric vs Surgical Necrosectomy for Infected Necrotizing Pancreatitis[J].JAMA, 2012, 10(307): 1053-1061.DOI:ISRCTN07091918.

Tan V Charachon A Lescot T Endoscopic transgastric versus surgical necrosectomy in infected pancreatic necrosis Clin Res Hepatol Gastroenterol 2014 38 6 770 776 10.1016/j.clinre.2014.06.016 Tan V, Charachon A, Lescot T, et al.Endoscopic transgastric versus surgical necrosectomy in infected pancreatic necrosis[J].Clin Res Hepatol Gastroenterol, 2014, 38(6): 770-776.DOI:10.1016/j.clinre.2014.06.016.

Pascual I Sabater L Añón R Surgical versus nonsurgical treatment of infected pancreatic necrosis: more arguments to change the paradigm J Gastrointest Surg 2013 17 9 1627 1633 10.1007/s11605-013-2266-6 Pascual I, Sabater L, Añón R, et al.Surgical versus nonsurgical treatment of infected pancreatic necrosis: more arguments to change the paradigm[J].J Gastrointest Surg, 2013, 17(9): 1627-1633.DOI:10.1007/s11605-013-2266-6.

Cirocchi R Trastulli S Desiderio J Minimally invasive necrosectomy versus conventional surgery in the treatment of infected pancreatic necrosis: a systematic review and a meta-analysis of comparative studies Surg Laparosc Endosc Percutan Tech 2013 23 1 8 20 10.1097/SLE.0b013e3182754bca Cirocchi R, Trastulli S, Desiderio J, et al.Minimally invasive necrosectomy versus conventional surgery in the treatment of infected pancreatic necrosis: a systematic review and a meta-analysis of comparative studies[J].Surg Laparosc Endosc Percutan Tech, 2013, 23(1): 8-20.DOI:10.1097/SLE.0b013e3182754bca.

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