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>Laparotomy versus retroperitoneal laparoscopy in debridement and drainage of retroperitoneal infected necrosis in severe acute pancreatitis.
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Laparotomy versus retroperitoneal laparoscopy in debridement and drainage of retroperitoneal infected necrosis in severe acute pancreatitis.
The aim of this study was to compare laparotomy and retroperitoneal laparoscopy in debridement and drainage of retroperitoneal infected necrosis of severe acute pancreatitis (SAP), and to evaluate the curative efficacy and the timing of retroperitoneal laparoscopic debridement drainage (RLDD) for SAP patients.We performed a retrospective analysis of 50 SAP cases, including 18 patients in the RLDD group and 32 patients in the laparotomy group. Observed indices included gender, age, CT severity index, Ranson score, APACHE II score, preoperative course, length of stay, operation time, mortality, postoperative complications, drainage tube indwelling time, and change of body temperature and peripheral white blood cell (PWBC) count between the time before the operation and at 48 h after surgery.Between the RLDD group and the laparotomy group, there was a significant difference in operation time (130 ± 15 vs. 148 ± 25 h; P = 0.007), length of stay [40.8 (6-121) vs. 55.9 (28-133) days; P = 0.053], and preoperative course [14.7 (5-31) vs. 18.3 (6-31) days; P = 0.05], but no significant difference in average drainage tube indwelling time [44.4 (2-182) vs. 49.8 (2-175) days; P = 0.663]. More improvement in body temperature and PWBC count was observed in the patients of the RLDD group. There was one death (1/18) in the RLDD group and four (4/32) in the laparotomy group. Fourteen cases (14/32) in the laparotomy group had postoperative complications, including pancreatic fistula (n = 11), intestinal fistula (n = 2), retroperitoneal hemorrhage (n = 2), infection of incision (n = 9), and 5 cases (5/18) in the RLDD group, including pancreatic fistula (n = 4) and retroperitoneal hemorrhage (n = 1).RLDD, as minimally invasive surgery, is technically feasible, safe, and effective in the treatment of retroperitoneal infected necrosis in SAP patients, in contrast to the laparotomy technique, and can be performed in the early phase of SAP to prevent the deterioration of the disease.
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机译：这项研究的目的是比较剖腹术和腹膜后腹腔镜在重症急性胰腺炎（SAP）腹膜后感染坏死的清创和引流中的应用，并评估SAP腹腔镜后腹腔镜清创引流（RLDD）的疗效和时机。对50例SAP病例进行了回顾性分析，其中RLDD组为18例，剖腹手术组为32例。观察到的指标包括性别，年龄，CT严重程度指标，Ranson评分，APACHE II评分，术前病程，住院时间，手术时间，死亡率，术后并发症，引流管留置时间以及体温和外周血白细胞（PWBC）的变化）在手术前和手术后48小时之间进行计数.RLDD组和剖腹手术组之间的手术时间有明显差异（130±15 vs. 148±25 h; P = 0.007），长度停留[40.8（6-121）天; 55.9（28-133）天; P = 0.053]，术前病程[14.7（5-31）天，相对于18.3（6-31）天; P = 0.05]，但平均引流管留置时间[44.4（2-182）天与49.8（2-175）天没有显着差异; P = 0.663]。 RLDD组患者的体温和PWBC计数有更多改善。 RLDD组有1例死亡（1/18），剖腹手术组有4例（4/32）。开腹手术组中有14例（14/32）术后并发症，包括胰瘘（n = 11），肠瘘（n = 2），腹膜后出血（n = 2），切口感染（n = 9）和RLDD组5例（5/18），包括胰瘘（n = 4）和腹膜后出血（n = 1）.RLDD作为微创手术，在技术上是可行，安全且有效的，用于治疗腹膜后感染与开腹手术相反，SAP患者可发生坏死，可在SAP早期进行以防止疾病恶化。
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