Retrospective Analysis Between Open Surgical Drainage And Percutaneous Catheter Drainage In Infected Pancreatic Necrosis

BackgroundAcute pancreatitis is an inflammatory clinical emergency,its incidence is high.In most cases,the disease is mild and self-limited.however,it is reported that about 20% to 30% of Patients with acute pancreatitis will develop necrotizing pancreatitis,the necrotic material further accumulates and is complicated with infection,which finally leads to the appearance of pancreatic infected pancreatic necrosis.In the first few weeks of the course of the disease,there will be further systemic inflammatory response syndrome and other conditions.The persistence of systemic inflammatory response syndrome is related to further organ failure and poor prognosis.Early intervention of infected pancreatic necrosis has a significant impact on the follow-up progress of the disease,so early unobstructed drainage is particularly important in improving the follow-up progress of the disease.In the past,due to the limitation of medical devices,the drainage of infected pancreatic necrosis was mainly open surgery.In recent years,with the vigorous development of minimally invasive technology,the concept of minimally invasive has gradually taken root in the hearts of the people,a variety of new drainage methods have gradually emerged,such as percutaneous catheter drainage,endoscopic ultrasonography drainage and video-assisted or laparoscopic necrotic clearance and so on.However,due to the limitation that medical equipment has not been widely used in most medical institutions,open surgical drainage and percutaneous catheter drainage are still the main methods of drainage in clinic.ObjectiveThe purpose of this paper is to make a retrospective analysis of the clinical patients with infected pancreatic necrosis.From January 2008 to September 2019,the patients with acute pancreatitis complicated with infected pancreatic necrosis treated in the Department of Hepatobiliary surgery of the second affiliated Hospital of Chongqing Medical University were collected and followed up,and the two groups of patients between open surgical drainage and PCD drainage were analyzed retrospectively.In order to objectively evaluate the advantages and disadvantages and clinical characteristics of the two kinds of drainage,and provide more reference for the selection of clinical drainage methods.MethodAccording to the inclusion criteria and exclusion criteria,47 inpatients in the Department of Hepatobiliary surgery of the second affiliated Hospital of Chongqing Medical University from January 2008 to September 2019 were divided into open surgical drainage group and percutaneous catheter drainage group according to different drainage methods.The clinical data of the two groups were collected and the clinical symptoms of the two groups before and after drainage were analyzed.The changes of related infection indexes(white blood cell,procalcitonin,C-reactive protein),complications after drainage,hospital stay and long-term recurrence were analyzed retrospectively.ResultsThere are 47 patients are included,19(40.4%)received open surgical drainage and 28(59.6%)received percutaneous catheter drainage.In basic data,there was no significant difference in sex,age,etiology and other clinical features.Both of the two drainage methods could relieve abdominal pain and reduce infection indexes(white blood cell,procalcitonin,C-reactive protein,etc.),but there was no significant difference in the days of abdominal pain relief(P=0.247)and infection reduction indexes(P>0.05)between the two groups.In the comparison of postoperative complications after drainage,there were fewer complications in the percutaneous catheter drainage group(P=0.044).In terms of hospital stay,the hospital stay of percutaneous catheter drainage group was shorter(P=0.01),but there was no significant difference between the two groups in terms of recurrence rate(P=0.343)and recurrence days(P=0.226).Therefore,as far as this study is concerned,the percutaneous catheter drainage group is better than the open surgery drainage group.ConclusionPatients with acute pancreatitis complicated with infected pancreatic necrosis treated with percutaneous catheter drainage can effectively reduce postoperative complications and hospital stay.There is no significant difference in relieving abdominal pain and reducing infection indicators between the two groups,and there is no significant difference in long-term recurrence rate and recurrence time.Compared with open surgical drainage,percutaneous catheter drainage has more advantages in the concept of minimally invasive.