Surgical management of acute pancreatitis in Italy: lessons from a prospective multicentre study

被引:25
作者
De Rai, Paolo [1 ]
Zerbi, Alessandro [2 ]
Castoldi, Laura [1 ]
Bassi, Claudio [3 ]
Frulloni, Luca [4 ]
Uomo, Generoso [5 ]
Gabbrielli, Armando [4 ]
Pezzilli, Raffaele [6 ]
Cavallini, Giorgio [4 ]
Di Carlo, Valerio [7 ]
机构
[1] Fdn Ist Ricovero & Cura Carattere Sci IRCCS Inst, Dept Surg & Emergency Surg, Milan, Italy
[2] IRCCS Ist Clin Humanitas, Dept Surg, Pancreat Surg Sect, Humanitas Clin Inst, Rozzano, Italy
[3] Univ Verona, Dept Surg, I-37100 Verona, Italy
[4] Univ Verona, Dept Gastroenterol, I-37100 Verona, Italy
[5] Cardarelli Hosp, Dept Internal Med, Naples, Italy
[6] St Orsola Malpighi Hosp, Dept Digest Dis & Internal Med, Pancreas Unit, Bologna, Italy
[7] IRCCS San Raffaele, Dept Surg, Milan, Italy
关键词
surgery; acute pancreatitis; ACUTE GALLSTONE PANCREATITIS; LAPAROSCOPIC CHOLECYSTECTOMY; NATIONAL GUIDELINES; AUDIT; INTERVENTION; STANDARDS;
D O I
10.1111/j.1477-2574.2010.00201.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Objective: This study aimed to evaluate the surgical treatment of acute pancreatitis in Italy and to assess compliance with international guidelines. Methods: A series of 1173 patients in 56 hospitals were prospectively enrolled and their data analysed. Results: Twenty-nine patients with severe pancreatitis underwent surgical intervention. Necrosectomy was performed in 26 patients, associated with postoperative lavage in 70% of cases. A feeding jejunostomy was added in 37% of cases. Mortality was 21%. Of the patients with mild pancreatitis, 714 patients with a biliary aetiology were evaluated. Prophylactic treatment of relapses was carried out in 212 patients (36%) by cholecystectomy and in 161 using a laparoscopic approach. Preoperative endoscopic retrograde cholangiopancreatography was associated with cholecystectomy in 83 patients (39%). Forty-seven patients (22%) were treated at a second admission, with a median delay of 31 days from the onset of pancreatitis. Eighteen patients with severe pancreatitis underwent cholecystectomy 37.9 days after the first admission. There were no deaths. Discussion: The results indicate poor compliance with published guidelines. In severe pancreatitis, early surgical intervention is frequently performed and enteral feeding is seldom used. Only a small number of patients with mild biliary pancreatitis undergo definitive treatment (i.e. cholecystectomy) within 4 weeks of the onset of pancreatitis.
引用
收藏
页码:597 / 604
页数:8
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