| Objective:To compare and analyze the clinical efficacy of retroperitoneal single-pore nephroscopy and traditional open surgery on infectious necrotizing pancreatitis.Methods:A retrospective analysis of 256 patients with infectious necrotizing pancreatitis admitted to the Department of Hepatobiliary Surgery of Jiangxi Provincial People ’ s Hospital from January 2012 to January 2022 was performed.58 patients who met the inclusion and exclusion criteria were screened.According to the surgical methods,they were divided into group A and group B.26 patients in group A were treated with retroperitoneal single-port nephroscope necrosis debridement,and 32 patients in group B were treated with traditional open abdominal surgery.The operation time,incidence of major perioperative complications,postoperative hospital stay,changes of related inflammatory indexes before and after operation,and hospitalization expenses were compared and analyzed between the two groups.Results:There was no significant difference in age,gender,other preoperative diseases,preoperative related inflammatory indicators,and preoperative severity assessment between the two groups(P > 0.05).There were five patients in group A with perioperative complications,and the incidence of complications was 19.2 %.Among them,three patients continued to draw bloody liquid from the drainage tube after operation,and the bleeding in the abscess cavity was considered.One patient had a sudden and sharp increase in amylase concentration in drainage fluid one week after operation.Combined with the clinical manifestations of the patient,the diagnosis of postoperative pancreatic fistula was considered.Postoperative atelectasis secondary infection occurred in 1 patient;no incisional hernia or other complications occurred after 6 months follow-up.In group B,19 patients had postoperative complications,with the incidence rate of 59.4 %.Among them,2 patients had postoperative abdominal bleeding,1 patient had postoperative pulmonary atelectasis and secondary pulmonary infection,7 patients had incisional infection,1 patient had pancreatic fistula,1 patient had intraoperative gastrointestinal injury,and 7 patients had incisional hernia after 6 months of follow-up.The difference in the incidence of total complications between the two groups was statistically significant(P = 0.002).The average operation time was(61.5 ± 7.6)min in group A and(71.8 ± 18.9)min in group B,and the difference was statistically significant(P < 0.05).The average blood loss was(20.7 ± 8.3)ml in group A and(78.8 ± 25.1)ml in group B,and the difference was statistically significant(P < 0.05).In terms of postoperative hospital stay,the average hospital stay in group A was(20.5 ± 10.9)d,and that in group B was(28.8 ± 8.1)d.The difference between the two groups was statistically significant(P = 0.04).The average hospitalization cost of group A(4.6 ± 2.1)million yuan was lower than that of group B(6.7 ± 3.7)million yuan,and the difference was statistically significant(P < 0.05).In terms of postoperative application of analgesics,4 patients in group A needed continuous application of analgesics after operation(> 24 h),and 30 patients in group B needed continuous application of analgesics to relieve incision pain.The difference between the two groups was statistically significant(P < 0.05).The difference in related inflammatory indexes between the two groups on the 5th and 7th days after operation was statistically significant(P < 0.05)but no significant difference on the 3th days(P > 0.05).Conclusion:1.Compared with traditional open surgery,retroperitoneal single-port nephro-scope has shorter operation time,fewer surgical complications,lower hospita lization costs,faster postoperative recovery,does not require general anesthesia,And it can also be used for repeated surgery.Especially for patients with poor preoperative general situation,can not tolerate large surgery,nephroscope as the preferred debridement.2.For pancreatic necrotic lesions with large range or deep location(such as the back of stomach,the head of pancreas and its upper part),the debridement efficiency of nephroscope is lower than that of open surgery,and the latter can simultaneously deal with other complications(such as gastrointestinal fistula,bleeding,abdominal compartment syndrome,biliary calculi).3.The surgical treatment of infectious pancreatic necrosis should not be limited to a single way.The preoperative general condition,complications,infection site and other factors should be fully evaluated to select the appropriate individualized way,and different ways can be combined as part of the step-up treatment. |
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