Preoperative Factors Influence Outcome After Surgery For Non-biliary Severe Acute Pancreatits

Acute pancreatitis is one of the most common acute abdomen, in which 15%~20% is severe acute pancreatitis(SAP), with complex manifestation, progressing quickly, severe complication, and high death rate at 10%~30%. From 1889, Fitz took a complete description of SAP firstly, the therapeutics of SAP has been discussing passionately. Nordmanna took a conclusion that surgery was harm for SAP, in the 1938's German surgery conference. In the mean while, drug therapeutics had a big development, pancreatic exocrine inhibitor and high efficient antibiotics were used in clinic, surgery died away in the therapy of SAP. In 1963, Watts etc cured the pancreatitis by pancreatic resection with great success, the position of surgical therapy was reconfirmed. However, the clinical death rate of SAP was still high, its curative effect can't satisfied. Ordinary, biliary pancreatitis would recommend to surgery and with well prognoses; we object to retrospective analyses 24 surgical cases of non-biliary pancreatitis from August 1995 to August 2007 in our hospital, study the factors which influence the therapeutic results.Methods: All analytical cases coincident with the golden criteria distributed by Chinese Medical Association, excluding the biliary pancreatitis. 24 cases were distributed into early surgery group and late surgery group according to surgical time, compared their survival rate. On the other hand, 24 cases were distributed into survival group and death group, compared their mean age, mean surgical time, Ranson's scores, Binder complication scores before surgery, and surgical indication. Data collection included sex, age, pancreatic CT sign, surgical time from onset, surgical indication, surgical methods, therapeutic results, Ranson's scores, Binder complication scores before and after surgery, survival rate, and so on.Result: early surgery group 15 cases, survived 9 cases; late surgery group 9 cases, survived 6 cases; the survival rate between the two groups without statistical significant difference. There are not significant difference in mean age, mean Ranson's scores, and mean surgical time between survival group (15 cases) and death group (9 cases). While the Binder complication scores before surgery of death group is higher than survival group with statistical significance, P<0.05. SAP patients usually come about a lot of complications, the most frequent organ and metabolic complications are: high serum glucose 13 cases (51.2%), systemic infection 13 cases (51.2%), peritonitis 12 cases (50.0%), bowel paralyses 10 cases (41.7%), low serum calcium 8 cases (33.3%), renal dysfunction 6 cases (25.0%). Shock, renal dysfunction, systemic infection, low serum calcium, and pancreatic encephalopathy are critical complications co-relate to death of non-biliary severe acute pancreatits, in which 2 cases manifest shock and 3 cases manifest pancreatic encephalopathy were totally die.Discussion: At present, therapeutic tendency of SAP is put off surgery, taking pancreatic necrotic debridement after one month, can reduce surgical death rate apparently. However, our data suggest that surgical time not the key point affect survival rate; although the survival group mean surgical time 11.5 dates later than the death group, there isn't statistical significant difference. De Waele etc had the similar findings on aboard. For lot of conservative therapeutics making great progress, sometimes we insist on non-surgical therapy or late surgery, result in some patients taking their life price. De Waele etc found that SAP death rate after surgery nothing to do with surgical time, just correlate to patients'age, organ function and necrotic degree. Our data suggest that there isn't significant difference between ages and Ranson's scores in the survival and death group, P>0.10; Binder complication scores before surgery have statistical significant difference between two groups, P<0.05. It demonstrates that every index in Binder complication scores would be good for assessing prognosis before surgery, and could be the reference for operation indication. While we insist on late surgery or non-surgery, would lead to severe metabolic or organ complication, and patient loss life.Conclusion:â‘ Timing of surgery is not the key factor influence surgical therapeutic result.â‘¡Binder complication score is a good index for assessing prognoses.