Pancreas · 2007
The efficacy of nonsurgical treatment of infected pancreatic necrosis.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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История · было → стало
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Lee Jun Kyu, Kwak Kyeong Keun, Park Joo Kyung, Yoon Won Jae, Lee Sang Hyub, Ryu Ji Kon, Kim Yong-Tae, Yoon Yong Bum
Аннотация
OBJECTIVES: We conducted this study to evaluate the efficacy of nonsurgical treatment for patients with infected pancreatic necrosis (IPN).
METHODS: Among 224 patients with acute pancreatitis from 2000 to 2004, there were 31 patients diagnosed as having IPN complication. The diagnostic criteria for IPN were either a positive culture or free gas in the pancreas of patients with acute pancreatic necrosis. Nonsurgical management including percutaneous drainage or endoscopic drainage (ED) followed by vigorous irrigation was initially attempted in all patients. Surgery was planned only when there was no clinical improvement after the initial nonsurgical treatment.
RESULTS: Percutaneous drainage or ED was performed in 18 and 5 patients, respectively. Eight patients received antibiotics only. Four patients (12.9%) (3 from percutaneous drainage group and 1 from ED group) required surgery. Sepsis or fistula developed in 32% and 6% of patients, respectively, and was managed successfully. One patient (3.2%) died as a result of rapidly progressing multiorgan failure. The mean duration of hospitalization was 37 days. During the follow-up period, 7 patients were readmitted because of fever; they were managed by reposition of the drainage tube.
CONCLUSIONS: Intensive nonsurgical treatment is very effective and safe and should be considered as an initial treatment modality for patients with IPN.
METHODS: Among 224 patients with acute pancreatitis from 2000 to 2004, there were 31 patients diagnosed as having IPN complication. The diagnostic criteria for IPN were either a positive culture or free gas in the pancreas of patients with acute pancreatic necrosis. Nonsurgical management including percutaneous drainage or endoscopic drainage (ED) followed by vigorous irrigation was initially attempted in all patients. Surgery was planned only when there was no clinical improvement after the initial nonsurgical treatment.
RESULTS: Percutaneous drainage or ED was performed in 18 and 5 patients, respectively. Eight patients received antibiotics only. Four patients (12.9%) (3 from percutaneous drainage group and 1 from ED group) required surgery. Sepsis or fistula developed in 32% and 6% of patients, respectively, and was managed successfully. One patient (3.2%) died as a result of rapidly progressing multiorgan failure. The mean duration of hospitalization was 37 days. During the follow-up period, 7 patients were readmitted because of fever; they were managed by reposition of the drainage tube.
CONCLUSIONS: Intensive nonsurgical treatment is very effective and safe and should be considered as an initial treatment modality for patients with IPN.
Предметные рубрики MeSH
AcinetobacterAdultAnti-Bacterial AgentsBacterial InfectionsDrainageDrug Administration ScheduleDrug Therapy, CombinationEndoscopy, Digestive SystemEnterococcusEscherichia coliFemaleFollow-Up StudiesHumansLength of StayMaleMiddle AgedPancreatitis, Acute NecrotizingPseudomonasRecurrenceStaphylococcus aureusStenotrophomonas maltophiliaStreptococcusTherapeutic IrrigationTime FactorsTreatment Outcome