Open necrosectomy combined with continuous positive drainage and prophylactic diverting loop ileostomy for late infected pancreatic necrosis: a retrospective cohort study

被引：3

作者：

Niu, Dong-Guang ^{[1
,2
]}

Li, Wei-Qin ^{[1
]}

Huang, Qian ^{[1
]}

Yang, Fan ^{[1
]}

Tian, Wei-Liang ^{[1
]}

Li, Chen ^{[3
]}

Ding, Lian-An ^{[2
]}

Fang, Hong-Chun ^{[2
]}

Zhao, Yun-Zhao ^{[1
,4
]}

机构：

[1] Nanjing Med Univ, Jinling Clin Coll, Dept Gen Surg, Nanjing 210002, Jiangsu, Peoples R China

[2] Qingdao Univ, Affiliated Hosp, Gastrointestinal Surg Dept, Qingdao 266000, Shandong, Peoples R China

[3] Xintai Peoples Hosp, Oncol Dept, Tai An 271200, Shandong, Peoples R China

[4] Nanjing Med Univ, Jinling Clin Coll, Dept Gen Surg, 305 East Zhongshan Rd, Nanjing 210000, Jiangsu, Peoples R China

来源：

BMC GASTROENTEROLOGY | 2020年 / 20卷 / 01期

关键词：

Infected pancreatic necrosis; Open necrosectomy; Prophylactic diverting loop ileostomy; Continuous positive drainage; ACUTE NECROTIZING PANCREATITIS; COLONIC COMPLICATIONS; SURGICAL-MANAGEMENT; CLOSED PACKING; DEBRIDEMENT; CLASSIFICATION; INVOLVEMENT; GUIDELINES; EXPERIENCE; MORTALITY;

D O I：

10.1186/s12876-020-01343-7

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background To evaluate an innovative open necrosectomy strategy with continuous positive drainage and prophylactic diverting loop ileostomy for the management of late infected pancreatic necrosis (LIPN). Methods Consecutive patients were divided into open necrosectomy (ON) group (n = 23), open necrosectomy with colonic segment resection (ON+CSR) group (n = 8) and open necrosectomy with prophylactic diverting loop ileostomy (ON+PDLI) group (n = 11). Continuous positive drainage (CPD) via double-lumen irrigation-suction tube (DLIST) was performed in ON+PDLI group. The primary endpoints were duration of organ failure after surgery, postoperative complication, the rate of re-surgery and mortality. The secondary endpoints were duration of hospitalization, cost, time interval between open surgery and total enteral nutrition (TEN). Results The recovery time of organ function in ON+PDLI group was shorter than that in other two groups. Colonic complications occurred in 13 patients (56.5%) in the ON group and 3 patients (27.3%) in the ON+PDLI group (p = 0.11). The length of stay in the ON+PDLI group was shorter than the ON group (p = 0.001). The hospitalization cost in the ON+PDLI group was less than the ON group (p = 0.0052). Conclusion ON+PDLI can avoid the intestinal dysfunction, re-ileostomy, the resection of innocent colon and reduce the intraoperative trauma. Despite being of colonic complications before or during operation, CPD + PDLI may show superior effectiveness, safety, and convenience in LIPN.

引用

页数：11