Risk factors for open pancreatic necrosectomy in patients with severe acute pancreatitis: An analysis based on the surgical step-up approach

Yuling DUAN; Zanjie FENG; Guoxin FAN; Lei WANG; Kangwei LIU; Cijun PENG

doi:10.3969/j.issn.1001-5256.2021.04.033

Volume 37 Issue 4

Apr. 2021

Turn off MathJax

Article Contents

Article Navigation > Journal of Clinical Hepatology > 2021 > 37(4): 893-897

PDF( 2166 KB)

Risk factors for open pancreatic necrosectomy in patients with severe acute pancreatitis: An analysis based on the surgical step-up approach

DOI: 10.3969/j.issn.1001-5256.2021.04.033

1.
Department of Hepatobiliary Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, China
2.
Department of Biochemistry and Molecular Biology, Zunyi Medical University, Zunyi, Guizhou 563000, China

Received Date: 2020-09-12
Accepted Date: 2020-12-08
Published Date: 2021-04-20

Abstract

Abstract

Objective To investigate the risk factors for open pancreatic necrosectomy (OPN), an effective treatment method for severe acute pancreatitis (SAP) after the failure of percutaneous catheter drainage (PCD), in patients with SAP. Methods A retrospective analysis was performed for 156 patients with SAP who underwent surgical intervention based on the step-up approach in The Affiliated Hospital of Zunyi Medical University from January 1, 2010 to June 30, 2018, and according to whether OPN was performed, the patients were divided into PCD group with 126 patients and PCD+OPN group with 30 patients. Related clinical data were collected, including age, sex, etiology, blood calcium on admission, white blood cell count on admission, whether CTSI score was >7, APACHE-Ⅱ score, Ranson score, presence or absence of peripancreatic fluid accumulation, presence or absence of infection, presence or absence of multiple organ failure (MOF), and whether PCD was performed at more than 1 week after admission. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups; a multivariate logistic regression analysis was used to determine the independent predictive factors for OPN. Results The probability of OPN was 19.2% for SAP patients in the later stage. Compared with the PCD+OPN group, the PCD group had a significantly lower proportion of patients with MOF on admission [27.0% (34/126) vs 70.0% (21/30), χ²=19.642, P < 0.01] and a significantly higher proportion of patients undergoing PCD at less than 1 week after admission [61.9% (78/126) vs 20.0% (6/30), χ²=17.121, P < 0.01]. MOF on admission (odds ratio [OR]=5.343, 95% confidence interval [CI]: 1.832-15.583, P < 0.05), initial PCD performed at more than 1 week after admission (OR= 5.518, 95% CI: 1.742-17.477, P < 0.05), and infection on admission (OR=5.016, 95% CI: 1.322-19.378, P < 0.05) were independent risk factors for subsequent OPN in SAP patients. Conclusion SAP with MOF on admission, initial PCD performed at more than 1 week after admission, and SAP with infection on admission are independent risk factors for subsequent OPN in SAP patients undergoing PCD in the early stage based on the step-up approach. Timely identification of related risk factors helps to grasp the timing of OPN in clinical practice and improve the clinical prognosis of SAP patients.
- Pancreatitis,
- Risk Factors,
- Step-up Surgery

FullText(HTML)

References(33)

References

[1]	PORTELLI M, JONES CD. Severe acute pancreatitis: Pathogenesis, diagnosis and surgical management[J]. Hepatobiliary Pancreat Dis Int, 2017, 16(2): 155-159. DOI: 10.1016/s1499-3872(16)60163-7.
[2]	GUO Q, LI A, XIA Q, et al. The role of organ failure and infection in necrotizing pancreatitis: A prospective study[J]. Ann Surg, 2014, 259(6): 1201-1207. DOI: 10.1097/SLA.0000000000000264.
[3]	PETROV MS, WINDSOR JA. Classification of the severity of acute pancreatitis: How many categories make sense?[J]. Am J Gastroenterol, 2010, 105(1): 74-76. DOI: 10.1038/ajg.2009.597.
[4]	BRADLEY EL 3rd, DEXTER ND. Management of severe acute pancreatitis: A surgical odyssey[J]. Ann Surg, 2010, 251(1): 6-17. DOI: 10.1097/SLA.0b013e3181c72b79.
[5]	VAN SANTVOORT HC, BESSELINK MG, BAKKER OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis[J]. N Engl J Med, 2010, 362(16): 1491-1502. DOI: 10.1056/NEJMoa0908821.
[6]	HOLLEMANS RA, BAKKER OJ, BOERMEESTER MA, et al. Superiority of step-up approach vs open necrosectomy in long-term follow-up of patients with necrotizing pancreatitis[J]. Gastroenterology, 2019, 156(4): 1016-1026. DOI: 10.1053/j.gastro.2018.10.045.
[7]	UHL W. Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis (Br J Surg 2011; 98: 18-27)[J]. Br J Surg, 2011, 98(1): 27-28. DOI: 10.1002/bjs.7309.
[8]	SUN B, JI L. Concerns relating the surgical management of severe acute pancreatitis[J]. Chin J Dig Surg, 2017, 16(10): 987-990. DOI: 10.3760/cma.j.issn.1673-9752.2017.10.003. 孙备, 冀亮. 重症急性胰腺炎外科干预应重视的问题[J]. 中华消化外科杂志, 2017, 16(10): 987-990. DOI: 10.3760/cma.j.issn.1673-9752.2017.10.003.
[9]	BELLAM BL, SAMANTA J, GUPTA P, et al. Predictors of outcome of percutaneous catheter drainage in patients with acute pancreatitis having acute fluid collection and development of a predictive model[J]. Pancreatology, 2019, 19(5): 658-664. DOI: 10.1016/j.pan.2019.05.467.
[10]	GUO Q, LI A, HU W. Predictive factors for successful ultrasound-guided percutaneous drainage in necrotizing pancreatitis[J]. Surg Endosc, 2016, 30(7): 2929-2934. DOI: 10.1007/s00464-015-4579-x.
[11]	Pancreas Study Group, Chinese Society of Gastroenterology, Chinese Medical Association; Editorial Board of Chinese Journal of Pancreatology; Editorial Board of Chinese Journal of Digestion. Chinese guidelines for the management of acute pancreatitis (Shenyang, 2019)[J]. J Clin Hepatol, 2019, 35(12): 2706 -2711. DOI: 10.3969/j.issn.1001-5256.2019.12.013. 中华医学会消化病学分会胰腺疾病学组, 中华胰腺病杂志编辑委员会, 中华消化杂志编辑委员会. 中国急性胰腺炎诊治指南(2019年, 沈阳)[J]. 临床肝胆病杂志, 2019, 35(12): 2706-2711. DOI: 10.3969/j.issn.1001-5256.2019.12.013.
[12]	LEI RQ, ZHANG SD. Significance of systemic inflammatory response in the pathogenesis of acute pancreatitis[J]. Chin J Hepatobiliary Surg, 2000, 6(1): 76. DOI: 10.3760/cma.j.issn.1007-8118.2000.01.033. 雷若庆, 张圣道. 全身炎症反应在急性胰腺炎发病机理中的意义[J]. 中华肝胆外科杂志, 2000, 6(1): 76. DOI: 10.3760/cma.j.issn.1007-8118.2000.01.033.
[13]	van BAAL MC, van SANTVOORT HC, BOLLEN TL, et al. Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis[J]. Br J Surg, 2011, 98(1): 18-27. DOI: 10.1002/bjs.7304.
[14]	SUN B, LI GQ. Surgical intervention strategies for local complications of severe acute pancreatitis[J]. Chin J Dig Surg, 2020, 19(4): 379-383. DOI: 10.3760/ cma.j.cn115610-20200121-00040. 孙备, 李冠群. 重症急性胰腺炎局部并发症外科干预策略[J]. 中华消化外科杂志, 2020, 19(4): 379-383. DOI: 10.3760/ cma.j.cn115610-20200121-00040.
[15]	BANKS PA, FREEMAN ML, Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis[J]. Am J Gastroenterol, 2006, 101(10): 2379-2400. DOI: 10.1111/j.1572-0241.2006.00856.x.
[16]	SHI N, LIU T, de la IGLESIA-GARCIA D, et al. Duration of organ failure impacts mortality in acute pancreatitis[J]. Gut, 2020, 69(3): 604-605. DOI: 10.1136/gutjnl-2019-318241.
[17]	ROCHA FG, BENOIT E, ZINNER MJ, et al. Impact of radiologic intervention on mortality in necrotizing pancreatitis: The role of organ failure[J]. Arch Surg, 2009, 144(3): 261-265. DOI: 10.1001/archsurg.2008.587.
[18]	SCHEPERS NJ, BAKKER OJ, BESSELINK MG, et al. Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis[J]. Gut, 2019, 68(6): 1044-1051. DOI: 10.1136/gutjnl-2017-314657.
[19]	TENNER S, BAILLIE J, DEWITT J, et al. American College of Gastroenterology guideline: Management of acute pancreatitis[J]. Am J Gastroenterol, 2013, 108(9): 1400-1415. DOI: 10.1038/ajg.2013.218.
[20]	BABU RY, GUPTA R, KANG M, et al. Predictors of surgery in patients with severe acute pancreatitis managed by the step-up approach[J]. Ann Surg, 2013, 257(4): 737-750. DOI: 10.1097/SLA.0b013e318269d25d.
[21]	JI L, WANG G, LI L, et al. Risk factors for the need of surgical necrosectomy after percutaneous catheter drainage in the management of infection secondary to necrotizing pancreatitis[J]. Pancreas, 2018, 47(4): 436-443. DOI: 10.1097/MPA.0000000000001031.
[22]	Italian Association for the Study of the Pancreas (AISP), PEZZILLI R, ZERBI A, et al. Consensus guidelines on severe acute pancreatitis[J]. Dig Liver Dis, 2015, 47(7): 532-543. DOI: 10.1016/j.dld.2015.03.022.
[23]	van GRINSVEN J, van SANTVOORT HC, BOERMEESTER MA, et al. Timing of catheter drainage in infected necrotizing pancreatitis[J]. Nat Rev Gastroenterol Hepatol, 2016, 13(5): 306-312. DOI: 10.1038/nrgastro.2016.23.
[24]	WANG YZ, ZHANG L, QIN T, et al. The individualized treatment of the severe acute pancreatitis[J]. Chin J Gen Surg, 2011, 20(3): 312-313. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWZ201103036.htm 王玉柱, 张莉, 秦涛, 等. 重症急性胰腺炎的个体化诊治体会[J]. 中国普通外科杂志, 2011, 20(3): 312-313. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWZ201103036.htm
[25]	ZHENG Q, LIU JS. Minimally invasive intervention strategy for severe acute pancreatitis[J]. J Clin Hepatol, 2020, 36(8): 1909-1912. DOI: 10.3969/j.issn.1001-5256.2020.08.051. 郑琦, 刘建生. 重症急性胰腺炎的微创干预策略[J]. 临床肝胆病杂志, 2020, 36(8): 1909-1912. DOI: 10.3969/j.issn.1001-5256.2020.08.051.
[26]	AI X, QIAN X, PAN W, et al. Ultrasound-guided percutaneous drainage may decrease the mortality of severe acute pancreatitis[J]. J Gastroenterol, 2010, 45(1): 77-85. DOI: 10.1007/s00535-009-0129-4.
[27]	SMIT M, BUDDINGH KT, BOSMA B, et al. Abdominal compartment syndrome and intra-abdominal ischemia in patients with severe acute pancreatitis[J]. World J Surg, 2016, 40(6): 1454-1461. DOI: 10.1007/s00268-015-3388-7.
[28]	TIAN H, LI FX, SONG SW. Features of infection secondary to severe acute pancreatitis and related control strategies[J]. J Clin Hepatol, 2019, 35(2): 451-456. DOI: 10.3969/j.issn.1001-5256.2019.02.048. 田浩, 李富兴, 宋少伟. 重症急性胰腺炎继发感染的特点及防治进展[J]. 临床肝胆病杂志, 2019, 35(2): 451-456. DOI: 10.3969/j.issn.1001-5256.2019.02.048.
[29]	BOSSCHA K, HULSTAERT PF, HENNIPMAN A, et al. Fulminant acute pancreatitis and infected necrosis: Results of open management of the abdomen and "planned" reoperations[J]. J Am Coll Surg, 1998, 187(3): 255-262. DOI: 10.1016/s1072-7515(98)00153-7.
[30]	Group of Pancreas Surgery, Chinese Society of Surgery, Chinese Medical Association. Guidelines for the management of acute pancreatitis(2014)[J]. J Clin Hepatol, 2015, 31(1): 17-20. DOI: 10.3969/j.issn.1001-5256.2015.01.004. 中华医学会外科学分会胰腺外科学组. 急性胰腺炎诊治指南(2014)[J]. 临床肝胆病杂志, 2015, 31(1): 17-20. DOI: 10.3969/j.issn.1001-5256.2015.01.004.
[31]	SORRENTINO L, CHIARA O, MUTIGNANI M, et al. Combined totally mini-invasive approach in necrotizing pancreatitis: A case report and systematic literature review[J]. World J Emerg Surg, 2017, 12: 16. DOI: 10.1186/s13017-017-0126-5.
[32]	ZHANG H, CHEN GY, XIAO L, et al. Ultrasonic/CT image fusion guidance facilitating percutaneous catheter drainage in treatment of acute pancreatitis complicated with infected walled-off necrosis[J]. Pancreatology, 2018, 18(6): 635-641. DOI: 10.1016/j.pan.2018.06.004.
[33]	YOKOI Y, KIKUYAMA M, KUROKAMI T, et al. Early dual drainage combining transpapillary endotherapy and percutaneous catheter drainage in patients with pancreatic fistula associated with severe acute pancreatitis[J]. Pancreatology, 2016, 16(4): 497-507. DOI: 10.1016/j.pan.2016.03.007.

Relative Articles

Supplements(0)

Cited By

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Figures(1) / Tables(2)

Get Citation

PDF

XML

Article Metrics

Article views (513) PDF downloads(38)

Risk factors for open pancreatic necrosectomy in patients with severe acute pancreatitis: An analysis based on the surgical step-up approach

DOI: 10.3969/j.issn.1001-5256.2021.04.033

Abstract

References

Proportional views

Catalog

通讯作者: 陈斌, bchen63@163.com

Article Metrics

Proportional views

Related

About Journal

Submission Guideline

Journal Online

Hepatobiliary College

Guidelines

Export File

Citation

Format

Content