Clinical Study Of Retroperitoneal Minimally Invasive Technique In The Treatment Of Severe Acute Pancreatitis Combined With Infected Pancreatic Necrosis

Objective:PCD is an important measure for the treatment of severe acute pancreatitis complicated with Infected Peripancreatic Necrosi.Effective PCD can prevent further deterioration of the disease.To compare the safety and efficacy aspects of the modified PCD treatment modality with the Step-up Approach two-stage minimally invasive surgical modality through a retrospective case analysis,and to evaluate its clinical efficacy to provide a clinical reference for the future treatment of severe acute pancreatitis combined with infected pancreatic necrosis.Methods:38 cases of SAP complicated with IPN diagnosed in our hospital from March 2014 to February 2022 were collected.All cases met the inclusion and exclusion criteria.All included patients received conventional PCD treatment.They were divided into two groups according to the treatment modality When they need further treatment:the modified PCD treatment group(16 cases)and the minimally invasive surgical treatment group(22 cases).Statistical software was used to analyze and compare the complications and death,complication incidence,mortality,multiple operation(puncture)rate,laboratory biochemical indicators,length of hospital stay,hospitalization costs and other items between the two groups.Results:1.All patients in the the modified PCD group were treated with modified PCD,of which 7 patients needed further ascending step minimally invasive surgery;All patients in the minimally invasive surgical group received minimally invasive surgery directly,and 1 patient received open surgery.2.Among the primary outcomes,there were 4 cases of complications and death in the modified PCD group and 8 cases of complications and death in the minimally invasive surgical group,which showed no significant difference in the primary outcomes between the two groups and the difference was not statistically significant(p>0.05).Among the secondary outcomes,1 case of gastrointestinal fistula,1 case of abdominal bleeding,1 case of infectious shock,2 case of pancreatic fistula,0 cases of death,and 15 cases of multiple surgeries(puncture)occurred in the modified PCD group;in the minimally invasive surgical group,4 cases of gastrointestinal fistula,4 cases of abdominal bleeding,2 cases of infectious shock,4 cases of pancreatic fistula,2 cases of death,and 7 cases of multiple surgeries(puncture)occurred.The results showed that the difference between the two groups was not significant in terms of complication rate and mortality rate,and the difference was not statistically significant(p>0.05),but the difference between the two groups was statistically significant in terms of multiple operations rate(p<0.05).3.The median postoperative blood leukocyte recovery time was 18.5 days(IQR 11.25-34.75)in the modified PCD group and 27 days(IQR 20.75-38)in the minimally invasive surgical group in both groups.The postoperative serum amylase recovery time was(19.56± 18.786)days in the modified PCD group and(20.91 ± 13.302)days in the minimally invasive surgical group.The postoperative serum lipase recovery time was(25.13±20.438)days in the modified PCD group and(19.64± 13.482)days in the minimally invasive surgical group.The postoperative serum albumin recovery time was(49.85±27.037)days in the modified PCD group and(29.33±20.063)days in the minimally invasive surgical group.The median number of hospitalization days after upgrading treatment modality was 44.50 days(IQR 29.50-67.00)in the modified PCD group and 31.50 days(IQR 23.25-51.75)in the minimally invasive surgical group.The hospitalization cost was(170,700 ± 106,400)thousand yuan in the modified PCD group and(167,200 ± 112,000)thousand yuan in the minimally invasive surgical group.After statistical analysis,comparing the differences between the two groups,the differences in postoperative blood leukocyte recovery time,postoperative serum amylase recovery time,postoperative serum lipase recovery time,hospitalization days after escalation treatment and hospitalization cost were not significant and the differences were not statistically significant(p>0.05).The postoperative serum albumin recovery time in modified PCD group was significantly longer than that in minimally invasive surgical group.The difference was significant and statistically significant(p<0.05).There was no statistically significant difference between the data of the two groups in terms of the number of days of hospitalization after escalation treatment,but from the numerical observation,it can be seen that the duration of postoperative hospitalization in the modified PCD group is longer.This may lead to a longer treatment period due to the presence of home treatment in some patients during the modified PCD treatment.Conclusion:The modified PCD treatment strategy has similar efficacy compared to minimally invasive surgery included in the Step-Up treatment strategy,but significantly increases the number of surgical operations and postoperative serum albumin recovery time.Clinical selection of IPN treatment should follow the principle of individual.