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1.
Am Surg ; 85(9): 1017-1024, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638517

RESUMO

Pancreatic necrosis can be managed conservatively; however, infection of pancreatic necrosis usually dictates more aggressive management. Our study aimed to assess the outcomes of open pancreatic necrosectomy (OPN) and endoscopic pancreatic necrosectomy (EPN) in a single center. Data from patients undergoing pancreatic necrosectomy at the Geisinger Medical Center from January 1, 2007, to April 25, 2016, were collected and retrospectively analyzed. Cohorts were composed of EPN (n = 22) and OPN (n = 34) groups. The prevalence of preoperative respiratory failure, septic shock, and multiorgan dysfunction syndrome was higher in the OPN group. The OPN group presented with a higher Bedside Index Severity in Acute Pancreatitis score. Postoperative abscess, persistent kidney dysfunction, and death were more frequent in the OPN group. The EPN group had a higher readmission rate. The results of the univariate analysis for complication and mortality demonstrated that higher mortality and persistent kidney dysfunction were associated with the procedure type, specifically OPN and with a higher Bedside Index Severity in Acute Pancreatitis score. Patients who presented with higher severity of disease underwent an OPN, whereas EPN often was performed successfully in a more benign clinical setting. However, patients with infected necrosis are served best in a tertiary medical facility where multiple treatment modalities are available.


Assuntos
Desbridamento/efeitos adversos , Desbridamento/métodos , Endoscopia/efeitos adversos , Pancreatite Necrosante Aguda/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/complicações , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
2.
Wiad Lek ; 72(9 cz 2): 1736-1739, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622257

RESUMO

OBJECTIVE: Introduction: The issue of surgical treatment of acute pancreatitis, in particular the choice of operative technique, is becoming increasingly relevant. The aim: To work out surgical approach in patients with acute complicated pancreatitis (ACP) using minimally invasive and traditional operative techniques. PATIENTS AND METHODS: Materials and methods: 170 patients underwent surgery for ACP. The main group (109 subjects) had minimally invasive techniques (MIT) dominated, the comparative group (61 subjects) - traditional operations. RESULTS: Results: MIT performed "as final" in 62 (69%), "stage"- in 16 (18%) and "stabilizing patient condition" - in 12 (13%) of observations. The number of combined interventions predominated in the main group - 26% and 12% (χ2=4.002; р=0.04), traditional in comparative groups - 67% and 17% cases (χ2=40.291; р<0.0001). Primary laparotomy operations were used in 41 (67%) patients from comparative and 19 (17%) patients from the main group (χ2=40.291; р<0.0001). The extent of traditional operations in the maingroup consisted predominantly of necrosequestrectomy with Beger closed drainage - in 26 (55%) and 15 (31%) observations, respectively (χ2=5.018; р=0.02). Necrosequestrectomy with subsequent stage lavage performed in common purulent-necrotic lesions were comparable in both groups - in 11 (23%) and 13 (26%) observations (χ2=0.0013; р>0.05). CONCLUSION: Conclusions: The worked out surgical treatment approach in ACP with individual and combined use of MIT and traditional operations resulted in decreased rates of postoperative complications from 13.1% to 8.3% and mortality from 14.8% to 9.2%.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos , Pancreatite Necrosante Aguda/cirurgia , Doença Aguda , Drenagem , Humanos , Laparotomia
3.
Zhonghua Wai Ke Za Zhi ; 57(10): 1-5, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31510724

RESUMO

Necrotizing pancreatitis is a complicated disease with multiple clinical outcomes. Although it's hard to select appropriate treatment strategies, it's still an important branch in improving the curative effect. The pathology and outcome of local complications of necrotizing pancreatitis show great diversity and individualized differences in different patients and stages of pathogenesis. Currently, a variety of treatment strategies for local complications of necrotizing pancreatitis, including minimally invasive treatment and laparotomy, can be selected. Removal of infected and necrotic tissues and adequate drainage of peripancreatic effusion are the basic principles. In clinical practice, minimally invasive and laparotomy strategies should be dialectically implemented according to the specific conditions and indications of patients. And we should avoid unilaterally emphasizing one method over the other or invariably using one method to deal with all patients' conditions. Clinical practice has proved that the choice of operation time is more decisive than the selection of debridement method to the success of treatment for local complications of necrotizing pancreatitis. As long as the operation time is appropriate, any debridement method can achieve good results. Therefore, we should avoid the overemphasis on debridement method, and ignore the significance of operation time for patients. In clinical practice, we are supposed to attach importance to the timing of intervention and selection of intervention methods according to the specific conditions of patients.


Assuntos
Pancreatite Necrosante Aguda/cirurgia , Desbridamento , Drenagem , Humanos , Laparotomia , Procedimentos Cirúrgicos Minimamente Invasivos , Medicina de Precisão , Tempo para o Tratamento , Resultado do Tratamento
4.
Zhonghua Wai Ke Za Zhi ; 57(10): 6-10, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31510725

RESUMO

With the development of minimally invasive concept, the treatment mode of severe acute pancreatitis has changed greatly. The tendency of surgical intervention has changed from excessive intervention to inadequate intervention. The timing of intervention has changed from earlier to later, and the mode of intervention has changed from openness as the main way to minimally invasive as the guidance. The transformation of surgical intervention tendency conforms to both minimally invasive trend and the step-up approach, but there are still some shortcomings: inadequate surgical intervention, inappropriate timing and indications, and over dependence on minimally invasive surgery. Correctly grasping the indications of surgical intervention, accurately grasping the timing of surgical intervention, and reasonably choosing the mode of surgical intervention are the keys to solve the insufficiency of surgical intervention. Laying emphasis on multidisciplinary team and correctly recognizing the role and status of surgical intervention can effectively reduce the mortality of severe acute pancreatitis patients.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/normas , Pancreatite Necrosante Aguda/cirurgia , Tempo para o Tratamento/normas , Doença Aguda , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Equipe de Assistência ao Paciente
5.
Zhonghua Wai Ke Za Zhi ; 57(10): 11-13, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31510726

RESUMO

The application of minimally invasive technique in infected pancreatic necrosis has been matured gradually but has controversy and challenges in the same time. This paper further discusses the advantages, timing, combination of multi-video-assisted debridement and post-operative management of minimally invasive surgery. The greatest advantage of minimally invasive surgery lies in "No intervention for normal abdominal space" which not only can reduce unnecessary injury and complication but also promote intestinal function recovery after operation. The principle of delayed operation is controversial. Early PCD and " one-step" minimally invasive laparoscopic debridement and drainage have both achieved good results. The combination of multi-video-assisted minimally invasive technique can make up for the shortage of single technique to shorten the operation time and improve the debridement efficiency of patients with complicated infected pancreatic necrosis and provide new ideas for video-assisted debridement. Fully debridement and drainage are the key points and standardization for post-operative management. It's a difficult problem and an important research direction to apply minimally invasive technique for patients with infected pancreatic necrosis reasonably and scientifically.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/normas , Pancreatite Necrosante Aguda/cirurgia , Desbridamento , Drenagem , Humanos , Laparoscopia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Cuidados Pós-Operatórios , Reoperação , Tempo para o Tratamento , Cirurgia Vídeoassistida
6.
Zhonghua Wai Ke Za Zhi ; 57(10): 14-18, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31510727

RESUMO

Objective: To investigate the changes of surgical invitations on necrotizing pancreatitis in recent 14 years by reviewing single center data. Methods: One thousand and eighty patients with necrotizing pancreatitis who received surgical invitation were involved in the study.All the patients were treated at Department of Pancreatic Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January 2005 to December 2018. Six hundred and seventy-eight were males and 402 were females. The median (range) age of the study patients was 45 (20-76) years.The etiology of the disease was related to cholelithiasis in 335 cases(31.02%), hyperlipemia in 302 cases(27.96%), alcohol in 226 cases(20.93%), endoscopic retrograde cholangiopancreatography in 28 cases(2.59%), pregnancy in 50 cases(4.63%), idiopathic factors in 72 cases(6.67%) and other causes in 67 cases(6.20%). The patients were divided into two groups according to the time of admission. Group 1 included 1 475 patients that admitted from January 2005 to December 2010, and group 2 included 1 539 patients that admitted from January 2011 to December 2018. The surgical interventions, morbidity and mortality of the two group were compared, and χ(2) test was used for the statistical test. Results: Two hundred and sixty-six among the 1 080 cases were treated with drainage procedures because of the pseudocyst.One hundred and seventy-five drainage procedures were performed between January 2005 and December 2018, which account for 11.87%(175 /1 475) of all patients of necrotizing pancreatitis; 91 drainage procedures were performed between January 2011 and December 2018,which account for 5.91%(91/1 539) of all patients of necrotizing pancreatitis. Eight hundred and fourteen cases received surgical intervention for infection of necrotizing tissues. Of these cases, 410 cases received percutaneous catheter drainage(PCD) of retroperitoneal fluid or residual infection. Debridement of necrotic tissues was performed on 756 cases. Of these cases, 32 cases received minimal invasive retroperitoneal debridement with/without denotes video assistant,4 cases received transluminal endoscopic debridement, 21 cases received laparoscopic debridement, and 709 cases received open laparotic debridement.Three hundred and sixty-five cases were admitted to our institute during January 2005 to December 2010, and the other 391 cases were admitted to our institute from January 2011 to December 2018. Of the first period, all debridement were performed with open laparotic procedures. Of the second period,debridement were performed with open laparotic procedures and minimal invasive procedures. The average times of surgical invasion, morbidity of principal local complications and mortality of the two periods were 1.27 and 1.34,28.22%(103/365) and 29.92%(117/346),and 6.03%(23/365) and 6.91%(27/346), respectively. Conclusions: Minimal invasive procedures can be considered for debridement in patients with necrotizing pancreatitis in some selected conditions.The involvements of minimal invasive procedures in treatment of necrotizing pancreatitis don't decrease the morbidity of principal local complications and mortality in recent years. Rational surgical procedures and appropriate surgical timing are the keys to improve the efficacy of necrotizing pancreatitis.


Assuntos
Pancreatite Necrosante Aguda/cirurgia , Espaço Retroperitoneal/cirurgia , Adulto , Idoso , Desbridamento/métodos , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pseudocisto Pancreático/etiologia , Pseudocisto Pancreático/cirurgia , Pancreatite Necrosante Aguda/complicações , Pancreatite Necrosante Aguda/mortalidade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
Zhonghua Wai Ke Za Zhi ; 57(10): 19-24, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31510728

RESUMO

Objective: To examine the indications and effects of different surgical approaches in laparoscopic debridement for patients with infected pancreatic necrosis(IPN). Methods: The clinical data of 213 IPN patients treated by laparoscopic debridement at Department of General Surgery,Xuanwu Hospital, Capital Medical University from June 2012 to February 2019 were retrospectively analyzed.The therapeutic effects were summarized and analyzed according to different surgical approaches. There were 123 cases in retroperitoneal approach group, including 73 males and 50 females, aging of (51.3±12.4)years; 59 cases in omental sac approach group, including 32 males and 27 females, aging of (48.3±14.2)years; 23 cases in combined approach group, including 13 males and 10 females,aging of(54.3±19.7)years;8 cases in digestive tract approach group, including 5 males and 3 females, aging of(50.2±12.5)years. Results: The time from onset to operation in retro-peritoneal, omental sac, combined and digestive tract approach groups were (44.3±22.8), (47.3±24.3), (52.6±21.2), (51.2±30.1)days, respectively; the operation time was (52.3±26.4), (64.3±29.2), (82.8±24.7), (78.2±38.1) minutes respectively; the median bleeding volume was 18, 33, 42 and 30 ml, respectively; and the first time to eat after operation was (2.5±1.6),(3.8±1.8),(3.7±2.0),(8.4±3.9) days, respectively. The incidence of complications (Clavien-Dindo grade Ⅲ and above)was 10.6%(13/123),10.2% (6/59),17.4%(4/23),1/8 and the mortality was 4.9%(6/123),3.4%(2/59),4.3%(1/23)and 0,respectively.The overall mortality of all patients was 4.2%(9/213).The levels of inflammatory factors were significantly lower in all groups 7 days after operation than before,and no patients was converted to open surgery. Conclusion: Individualized selection of the optimal laparoscopic debridement approach of pancreatic necrosis plays an important role in improving the efficacy and prognosis of IPN patients.


Assuntos
Desbridamento/métodos , Laparoscopia/métodos , Pancreatite Necrosante Aguda/cirurgia , Adulto , Idoso , Drenagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/complicações , Pancreatite Necrosante Aguda/mortalidade , Medicina de Precisão , Prognóstico , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
8.
Zhonghua Wai Ke Za Zhi ; 57(10): 25-30, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31510729

RESUMO

Objective: To investigate the prognostic factors of multi-drug resistant organism (MDRO) infection in patients with infected pancreatic necrosis(IPN). Methods: A retrospective study was performed to assess the MDRO in IPN patients. The clinical data of 104 IPN patients admitted to the Department of Pancreatic and Biliary Surgery, the First Affiliated Hospital of Harbin Medical University from June 2013 to January 2019 were analyzed. Fifty-six patients were allocated in the MDRO group and 48 patients in the non-MDRO group depended on drug sensitivity test. There were 37 males and 19 females in the MDRO group with age of 40 (23) years. The duration time was 3(5) days between onset and admission. In the non-MDRO group,34 males and 14 females were included with age of (42±14)years. The duration time was 3(4) days between onset and admission. Normally distributed quantitative variables was represented by x±s, non-normally distributed quantitative variables was represented by M(Q(R)). Wilcoxon rank-sum test and χ(2) test were used to analyze the data. Univariate and multivariable Logistic regression analytic model were used to figure out the risk factors associated with MDRO infection. Results: The mean duration of hospital stay was 29.5(31.8) days and hospitalization expenses were CNY 166 991(270 692), which were much higher than those in non-MDRO group (16.5(15.7) days, 56 789(62 354) yuan) (W=1 889, 2 019, both P<0.01). Gram-negative isolates(67.2%, 80 /119) were commonly detected in IPN patients. Acinetobacter baumannii was the most common MDRO(27.0%,20/74). Initial use of carbapenem(OR=2.22, 95%CI: 1.02-4.96, P=0.047) and open necrosectomy(OR=10.00, 95%CI: 3.14-44.77, P<0.01) were the potential risk factors for MDRO-induced infections in IPN. Furthermore, the Logistic regression analysis revealed that open necrosectomy is the independent variable for MDRO infections (OR=9.42, 95%CI: 2.92-42.42, P<0.01). Conclusion: Open necrosectomy was the independent risk factor for the infection of MDRO.


Assuntos
Desbridamento/efeitos adversos , Farmacorresistência Bacteriana Múltipla , Infecções por Bactérias Gram-Negativas/etiologia , Pancreatite Necrosante Aguda/microbiologia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Feminino , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/terapia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/cirurgia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
9.
Pancreatology ; 19(6): 828-833, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31383574

RESUMO

BACKGROUND: Use of minimally invasive techniques has reduced mortality in walled-off pancreatic necrosis (WON) but may be costly. The aim of this study was to evaluate the actual costs associated with the endoscopic management of patients with WON. METHODS: We included a retrospective cohort of WON patients treated with endoscopic, transgastric drainage and necrosectomy (ETDN) during 2013-2014. Costs were calculated for six sub-areas based on a micro-costing model. Students T-test and non-parametric analysis of variance were performed to evaluate costs in relation to disease etiology and outcome. RESULTS: We included 58 patients (50% men, median age 57 years). The most common etiologies were gallstones (57%) and alcohol (19%). Nine patients (16%) died during admission. The median length of stay was 50 days (IQR 31 days). Eighteen patients (31%) needed treatment in our intensive care unit with a median length of stay of 16 days (IQR 31 days). The mean costs and standard deviation of costs (SD) per patient were: diagnostic imaging $2,431 ($2,301), laboratory tests $3,579 ($2,477), blood products $982 ($1,734), endoscopic treatment $3,794 ($1,777), medicine $5,440 ($6,656), and ward cost $41,260 ($35,854). The mean total cost was $57,486 ($46,739). Post-ERCP pancreatitis and mortality predicted higher costs. CONCLUSIONS: This study sheds light on the different costs associated with endoscopic treatment of WON. As nearly three quarters of the costs are related to ward care, initiatives aimed at reducing the length of hospital stay may have a great impact on making endoscopic treatment more cost effective.


Assuntos
Endoscopia/economia , Pancreatite Necrosante Aguda/economia , Custos e Análise de Custo , Cuidados Críticos/economia , Cuidados Críticos/estatística & dados numéricos , Diagnóstico por Imagem/economia , Drenagem , Endoscopia/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/economia , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Pancreatite Necrosante Aguda/mortalidade , Pancreatite Necrosante Aguda/cirurgia , Estudos Retrospectivos , Stents , Análise de Sobrevida , Resultado do Tratamento
10.
Z Gastroenterol ; 57(7): 852-858, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31288281

RESUMO

Necrotizing pancreatitis remains a therapeutic challenge. Thirty-eight percent of all cases lead to an early organ failure and 15 % cause death. Interventions are necessary in 38 % 1.Due to lower mortality compared to open surgery, both endoscopic treatment and minimally invasive surgery are established 2.Endoscopic vacuum therapy can be an auxiliary method for this indication, with only a few case reports existing. Recommendation is still unclear, compared to standard methods like endoscopic necrosectomy, drainage and irrigation (see ESGE Guideline "Endoscopic management of acute necrotizing pancreatitis" 2018; Recommendation 4.2.8) 1.The actual case shows a successful endoscopic vacuum therapy of an infected walled-off pancreatic necrosis. A modified open-pore film drainage (OFD) is combined with endoscopic necrosectomy.


Assuntos
Endoscopia do Sistema Digestório/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pancreatectomia/métodos , Pancreatite Necrosante Aguda/cirurgia , Irrigação Terapêutica/métodos , Drenagem , Humanos , Pancreatite Necrosante Aguda/diagnóstico , Resultado do Tratamento , Vácuo
11.
Turk J Med Sci ; 49(4): 1079-1084, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31340633

RESUMO

Background/aim: This study aimed to investigate the effect of technical details of percutaneous catheter drainage (PCD) on the clinical outcomes of patients with infected necrotizing pancreatitis (INP). Materials and methods: A total of 44 INP patients treated in our hospital from October 2013 to October 2015 were included. The correlations of the first PCD treatment data and the clinical outcomes were analyzed. Results: The number of catheters was positively correlated with hospital readmission (r = 0.335, P = 0.032). Receiver operating characteristic curve analysis showed that patients with ≥ 3 catheters were more likely to have hospital readmission. Patients with pleural effusion undergoing thoracentesis were more likely to have new intensive care unit admission (P = 0.025) and bleeding in need of intervention (P = 0.032). Patients with more effusion regions had higher incidences of mortality (P = 0.012) and new intensive care unit admissions (2.44 ± 1.03 vs. 1.88 ± 0.80; P = 0.059). Patients with PCD only were less likely to have new intensive care unit admissions (22.22% vs. 54.55%; P = 0.038) than those with PCD + small incision or/and videoscopic assisted retroperitoneal debridement. Conclusion: Number of catheters greater than three was associated with unfavorable outcomes of PCD treatment in INP patients. Patients that received PCD treatment only had better outcomes.


Assuntos
Drenagem , Pancreatite Necrosante Aguda , Adulto , Cateteres , Desbridamento , Drenagem/efeitos adversos , Drenagem/métodos , Drenagem/mortalidade , Drenagem/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/epidemiologia , Pancreatite Necrosante Aguda/mortalidade , Pancreatite Necrosante Aguda/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Prognóstico , Curva ROC , Estudos Retrospectivos , Resultado do Tratamento
12.
BMC Endocr Disord ; 19(1): 82, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31357974

RESUMO

BACKGROUND: Primary hyperparathyroidism (PHPT), which is mostly caused by a parathyroid adenoma, is fairly common in postmenopausal women but is relatively rare in pregnant women. PHPT-induced pancreatitis during pregnancy is associated with significant maternal and foetal morbidity and mortality. Diagnosis is challenging because of non-specific symptoms and changes in maternal calcium homeostasis. Information about the optimal treatment strategy for the prevention of catastrophic consequences to the mother and foetus is limited. Here, we describe a rare lethal case of severe acute necrotizing pancreatitis due to a parathyroid adenoma in a woman in her third trimester of pregnancy. CASE PRESENTATION: A previously healthy 24-year-old Chinese woman at 37 weeks of gestation presented with persisting epigastric pain, nausea and bilious vomiting for 1 day. PHPT-induced acute necrotizing pancreatitis was diagnosed on the basis of her serum calcium, parathyroid levels and imaging results. A caesarean section and parathyroidectomy were performed at 1 day and 11 days after admission, respectively. Histological examination confirmed a right inferior parathyroid adenoma with a size of 2.0 × 1.5 cm. Following the parathyroidectomy, the patient had eucalcaemia and presented normal parathyroid hormone (PTH) levels. Although the foetus was normal, the patient died of multiple organ failure due to severe pancreatitis. CONCLUSIONS: PHPT-induced acute necrotizing pancreatitis is a rare clinical entity and life-threatening condition to both the mother and the foetus during pregnancy. Early diagnosis can be challenging and is crucial. Appropriate treatment according to the patient's condition may effectively reduce maternal and foetal mortality.


Assuntos
Pancreatite Necrosante Aguda/etiologia , Pancreatite Necrosante Aguda/cirurgia , Neoplasias das Paratireoides/complicações , Paratireoidectomia/métodos , Adulto , Feminino , Humanos , Pancreatite Necrosante Aguda/patologia , Gravidez , Terceiro Trimestre da Gravidez , Prognóstico , Índice de Gravidade de Doença , Adulto Jovem
13.
Medicine (Baltimore) ; 98(24): e16111, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192974

RESUMO

Infected necrotizing pancreatitis (INP), the leading cause of mortality in the late phase of acute pancreatitis, nearly always requires intervention. In recent years minimal invasive surgery is becoming more and more popular for the management of INP, but few studies compared different minimally invasive strategies. The objective of this observation study was to evaluate the safety and effectiveness with several minimal invasive treatment.We retrospectively reviewed cases of percutaneous catheter drainage (PCD), minimal access retroperitoneal pancreatic necrosectomy (MARPN), small incision pancreatic necrosectom (SIPN), single-incision access port retroperitoneoscopic debridement (SIAPRD) for INP between January 2013 and October 2018. Data were analyzed for the primary endpoints as well as secondary endpoints.Eighty-one patients with INP were treated by minimally invasive procedures including PCD (n = 32), MARPN (n = 18), SIPN (n = 16), and SIAPRD (n = 15). Overall mortality was greatest after PCD 34% (MARPN 11% vs SIPN 6% vs SIRLD6%). Problems after initial surgery were ongoing sepsis (PCD 56% vs MARPN 50% vs SIPN 31% vs SIAPRD13%; P < .05). There was a significant difference in number of interventions (median, 6 vs 5 vs 3 vs 2; P < .05). Time from onset of symptoms to recovery was less for SIAPRD than for PCD, MARPN, or SIPN (median, 45 vs 102 vs 80 vs 67 days; P < .05).SIAPRD remedy evidently improved outcomes, including systemic inflammatory response syndrome, number of interventions, length of hospital stay and overall cost. It is technically feasible, safe, and effective for INP, in contrast to others, and can achieve the best clinical results with the least cost. Furthermore, relevant multicentre randomized controlled trials are eager to prove these findings.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos , Pancreatite Necrosante Aguda/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/economia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pancreatite Necrosante Aguda/economia , Pancreatite Necrosante Aguda/epidemiologia , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
14.
Khirurgiia (Mosk) ; (3): 73-79, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30938360

RESUMO

AIM: The purpose of the study was to establish the effectiveness of Remaxol in restoring tissue reparative ability of laparotomy wound in acute severe pancreatitis. MATERIAL AND METHODS: The work is based on the results of experimental and clinical studies. Experiments were carried out using acute total pancreatic necrosis model under anesthesia on 30 dogs. Furthermore, 28 patients with acute severe pancreatitis were examined and underwent surgery on various purulent-necrotic complications. In the postoperative period, healing and metabolic processes were evaluated in the tissues along the sutures line of the laparotomy wound. Also, such parameters as endogenous intoxication, oxidative stress, and phospholipase activity were evaluated at the organism level. In the studied groups, Remaxol is included in the postoperative therapy. RESULTS: It has been established that during acute severe pancreatitis reparative potential of tissues is significantly reduced, which is caused by a significant disruption of trophism, activation of phospholipases and peroxidation of membrane lipids. Disorders of homeokinesis at the organism level play a negative role in tissue reparative potential reduction. Inclusion of Remaxol in the complex therapy of acute pancreatitis leads to a decrease in duration of wound healing by reduction in the phase of inflammation. Optimization of the healing process occurs due to complex effect of the drug at organ and body level, which results in improvement of the trophism and, what's more, stabilizes membranes of regenerating cells. CONCLUSION: In case of acute severe pancreatitis, the use of Remaxol in early postoperative period in the complex therapy leads to a significant correction of factors that adversely affect regeneration and contributes to the restoration of tissue reparative potential.


Assuntos
Antioxidantes/farmacologia , Pancreatite Necrosante Aguda/cirurgia , Succinatos/farmacologia , Ferida Cirúrgica/tratamento farmacológico , Cicatrização/efeitos dos fármacos , Animais , Antioxidantes/uso terapêutico , Cães , Humanos , Laparotomia , Estresse Oxidativo/efeitos dos fármacos , Pancreatite Necrosante Aguda/fisiopatologia , Succinatos/uso terapêutico , Ferida Cirúrgica/fisiopatologia , Cicatrização/fisiologia
16.
Magy Seb ; 72(1): 8-12, 2019 Mar.
Artigo em Húngaro | MEDLINE | ID: mdl-30869532

RESUMO

AIMS: In severe acute pancreatitis the timing of necrosectomy is ideally should be postponed 4-6 weeks after the onset of the disease when the walled-of pancreatic necrosis (WOPN) has developed. The authors present their experience with open transgastric necrosectomy for extended WOPN. PATIENTS AND METHODS: The authors performed 17 (12 male, 5 female with a mean age of 61.6 ± 15.1 years) open transgastric necrosectomies for extended WOPN in a period of 1, January 2012 and 31, December 2017. Before the operations conservative and semiconservative therapy was used for an average of 74.6 ± 83.1 days. The mean size of the WOPNs was 13.8 ± 5.2 cm with localisation of the retrocolic and retroduodenal regions. All necroses were septic. RESULTS: Complications related to the operation were not observed. The mean time of hospitalization after the surgery was 11.6 ± 12.8 days. The mortality rate was 5.9%. Late operation or other interventions for pseudocyst or pancreas fistula formation was not performed. Two patients needed endoscopic dilatation with lavage in the early postoperative period because of fever. New diabetes mellitus was not observed but worsening of previously existed diabetes developed in 6.3% of the cases. CONCLUSIONS: The open transgastric necrosectomy is safe and effective for extended WOPN. The advantage of this type of necrosectomy is the prevention of pancreatic pseudocyst and fistula formation.


Assuntos
Desbridamento/métodos , Laparoscopia/métodos , Pancreatectomia/métodos , Pancreatite Necrosante Aguda/cirurgia , Pancreatite Necrosante Aguda/terapia , Irrigação Terapêutica/métodos , Idoso , Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Pancreatite Necrosante Aguda/diagnóstico , Resultado do Tratamento
19.
Expert Rev Gastroenterol Hepatol ; 13(4): 331-343, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30791769

RESUMO

INTRODUCTION: Walled of pancreatic necrosis (WOPN) is a new term coined for encapsulated fluid collection developing after acute necrotising pancreatitis (ANP). It is a heterogeneous collection containing varying amount of liquid as well as solid necrotic material. The literature on its natural history as well as appropriate management is gradually expanding thereby improving treatment outcomes of this enigmatic disease. Areas covered: This review discusses currently available literature on etiology, frequency, natural history, and imaging features WOPN. Also, updated treatment options including endoscopic, radiological and surgical drainage are discussed. Expert opinion: WOPN is alocal complication of ANP occurring in the delayed phase of ANP and may be asymptomatic (50%) or present with pain, fever, jaundice, or gastric outlet obstruction. Natural courses of asymptomatic WOPN have been infrequently studied, and it appears that the majority remain asymptomatic and resolve spontaneously. Magnetic resonance imaging and endoscopic ultrasound are the best imaging modalities to evaluate solid necrotic debris. Symptomatic WOPN usually needs immediate drainage, this can be done endoscopically, radiologically, or surgically. Current evidence suggests that endoscopic transluminal drainage is the preferred drainage technique as it is effective and associated with lower mortality, risk of organ failure, adverse effects, and length of hospital stay.


Assuntos
Pâncreas , Pancreatite Necrosante Aguda , Drenagem/métodos , Endossonografia , Humanos , Imagem por Ressonância Magnética , Pâncreas/diagnóstico por imagem , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatite Necrosante Aguda/diagnóstico por imagem , Pancreatite Necrosante Aguda/epidemiologia , Pancreatite Necrosante Aguda/patologia , Pancreatite Necrosante Aguda/cirurgia , Valor Preditivo dos Testes , Fatores de Risco , Resultado do Tratamento
20.
Internist (Berl) ; 60(3): 226-234, 2019 03.
Artigo em Alemão | MEDLINE | ID: mdl-30805662

RESUMO

Acute pancreatitis (AP) has an annual incidence of 30-45 per 100,000 inhabitants. In Germany approximately one third of the cases are of biliary or alcoholic origin. The diagnosis is based on the typical epigastric pain with radiation and a threefold increase of lipase or amylase in serum. Imaging procedures only rarely need to be included for the primary diagnostics. An early risk assessment is important to be able to allocate patients with severe AP to surveillance in an intensive care unit (ICU). Elevation of blood urea nitrogen, hematocrit and blood glucose are early predictors of poor outcome.The removal of impacted gall-stones by endoscopic retrograde cholangiography (ERC) is the only causal treatment of biliary AP, which must be carried out when there are signs of cholangitis and in severe biliary AP. Pain management and early fluid substitution are the most important symptomatic approaches. In the early phase of AP 150-250 ml/h of crystalloid solution should be administered to compensate for the extravasal loss of fluid. In certain cases, the initial fluid requirement might be even higher. In the ICU setting echocardiography and advanced hemodynamic monitoring are available for guidance. Prophylactic antibiotic treatment is not recommended in mild AP and it is a matter of debate even in severe AP. Early enteral nutrition has been shown to improve the outcome. Even in cases of fluid collection and necrosis a primary surgery approach should be avoided in favor of a "step-up" procedure with radiologically guided drainage as well as endoscopic and if necessary video-assisted percutaneous retroperitoneal débridement. Surgery remains an option for complications and for infected necrosis which cannot be reached by any other means.


Assuntos
Desbridamento , Drenagem , Pancreatite Necrosante Aguda/diagnóstico , Pancreatite Necrosante Aguda/cirurgia , Colangiografia , Terapia Combinada/métodos , Alemanha , Humanos , Pancreatite Necrosante Aguda/diagnóstico por imagem
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