Analysis of a Step-Up Approach Versus Primary Open Surgical Necrosectomy in the Management of Necrotizing Pancreatitis: Experience in a Cohort of Patients at a US Academic Medical Center

被引：18

作者：

Jones, Jason D. ^{[1
]}

Clark, Clancy J. ^{[2
]}

Dyer, Raymond ^{[3
]}

Case, L. Douglas ^{[4
]}

Mishra, Girish ^{[1
]}

Pawa, Rishi ^{[1
]}

机构：

[1] Wake Forest Sch Med, Dept Med, Sect Gastroenterol & Hepatol, Winston Salem, NC USA

[2] Wake Forest Sch Med, Dept Surg Sci Oncol, Winston Salem, NC USA

[3] Wake Forest Sch Med, Dept Radiol, Winston Salem, NC USA

[4] Wake Forest Sch Med, Div Publ Hlth Sci, Dept Biostat Sci, Winston Salem, NC USA

来源：

PANCREAS | 2018年 / 47卷 / 10期

关键词：

necrotizing pancreatitis; walled-off pancreatic necrosis; step-up; surgical necrosectomy; ATLANTA CLASSIFICATION; NECROSIS; PSEUDOCYST;

D O I：

10.1097/MPA.0000000000001154

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Objectives An increasing number of providers have begun to use a minimally invasive step-up approach as opposed to traditional surgical necrosectomy in the management of acute necrotizing pancreatitis. Studies have shown mixed results, thus we hypothesized that the step-up approach is safer and associated with decreased mortality and length of stay (LOS). Methods This is a retrospective cohort study of patients admitted from January 2010 to March 2015 who underwent interventions for walled-off pancreatic necrosis (WOPN). Primary outcomes included LOS after intervention and mortality, in-hospital and 90-day, with secondary outcomes of procedural complications. Results Sixty-nine patients developed WOPN requiring intervention during the study period. In-hospital mortality was 5.6% (n = 2) in the step-up cohort compared with 18.2% (n = 6) in the surgical cohort (relative risk, 3.27; 95% confidence interval, 0.71-15.09). Ninety-day mortality was 9.1% (n = 3) in the step-up cohort and 21.9% (n = 7) in the surgical cohort (relative risk, 2.41; 95% confidence interval, 0.68-8.50). Postintervention LOS was 8 days in the step-up cohort and 17 days in the surgical cohort (P = 0.62). Conclusions A step-up approach, as compared with primary surgical necrosectomy in the management of WOPN, results in clinically significant decreases in mortality and LOS.

引用

页码：1317 / 1321

页数：5

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