Clinical Application of Percutaneous Gallbladder Drainage in Severe Acute Pancreatitis / 中国医科大学学报

Objective To investigate the clinical value of percutaneous gallbladder drainage in the treatment of severe acute pancreatitis(SAP). Methods A total of 65 patients treated for SAP in our hospital between January 2014 and April 2017 were analyzed retrospectively. The patients were divided into a gallbladder puncture group and a control group. Follow-up was performed for at least 6 months to monitor mortality and the incidence of complications, including pancreatic abscess, pseudocyst, renal failure, respiratory failure, heart failure, gastrointestinal bleeding, sepsis, and disseminated intravascular coagulation (DIC), The differences in mortality and complication rates between the two groups were statistically analyzed. Results Mortality in the gallbladder puncture group was significantly lower than in the control group (P ＜ 0. 05); the incidence of renal failure, respiratory failure, heart failure, gastrointestinal bleeding, and sepsis in the gallbladder puncture group was lower than in the control group (P ＜ 0. 05); the incidence of pancreatic abscess and pseudocyst in the gallbladder puncture group was similar to that in the control group, showing no significant difference (P ＞ 0. 05); the incidence of DIC in the gallbladder puncture group was lower than in the control group, but the difference was not statistically significant (P ＞ 0. 05). Conclusion Percutaneous gallbladder drainage can effectively reduce the incidence of renal failure, respiratory failure, heart failure, gastrointestinal bleeding, and sepsis in SAP, thereby reducing mortality. However, the incidence of DIC, pancreatic abscess, and pseudocyst is not reduced.

Diagnosis, treatment and prognosis of patients with acute pancreatitis / 中华肝胆外科杂志

Acute Pancreatitis Classification Working Group published Classification of Acute Pancreatitis-2012:Revision of the Atlanta Classification and Definitions by International Consensus in 2012,which redefined the diagnosis,severity,local complication,local infection of acute pancreatitis (AP).Under the guidance of revised Atlanta classification (RAC),the constituent ratio of severe acute pancreatitis (SAP) decreases significantly,which is between 3.7％ ～ 25.4％,and less than 10.0％ is reported in most researches.The mortality of SAP is between 10.0％ ～ 52.9％,and more than 20％ is observed in most publications.The constituent ratio of mild severe acute pancreatitis (MSAP) is between 10.9％ ～ 40.1％,the mortality is between 0 ～ 4.8％,and the incidence rate of organ failure is between 4.6％ ～ 34.0％.The percentage of patients with SAP who need ICU care and surgery intervention is higher than that of MSAP,and the total hospital stay of SAP are longer than that of MSAP.RAC could better reflect the severity and predict the outcome of AP than Atlanta classification published in 1992,but RAC also has some potential limitations.For example,the “local infection” is not included in this classification.This paper veviewed the relavent issues.