Clinical Efficacy Of The Timing Of Ultrasound-guided Percutaneous Catheter Drainage For Severe Acute Pancreatitis

Objective:Percutaneous catheter drainage(PCD)is an effective method for the treatment of local complications in patients with severe acute pancreatitis(SAP).However,the choice of treatment time remains controversial.By retrospective analysis of the clinical data of SAP patients,this study aims to assess the differences in the clinical efficacy of ultrasound-guided percutaneous catheter drainage performed at different periods with SAP patients,and explore the best time for PCD treatment.Methods:This retrospective study included clinical data of SAP patients treated with PCD in the Emergency Intensive Care Unit of the Affiliated Hospital of Qingdao University from January 2018 to December 2021.Inclusion criteria: adhere the diagnostic criteria of severe acute pancreatitis,first incidence of SAP and treated with PCD;patients age over 18 years old and under 75 years old;balthazar CT score was grade D or grade E;complete clinical data.Exclusion criteria: patients with chronic pancreatitis,suspected pancreatic cancer,recurrent pancreatitis;patients who had undergone PCD or other minimally invasive treatments and surgical procedures before admission;patients with underlying diseases such as cardiovascular(NYHA gradeⅢand above),respiratory(tuberculosis,lung malignancy,chronic respiratory failure),renal(chronic kidney disease,renal malignancy)or hepatic(Child-Pugh grade C and above,liver malignancy,chronic liver disease,cirrhosis)diseases;patients with immune dysfunction such as AIDS;pregnant females;patients who abandon treatment or transfer to another hospital.Patients were divided into two groups according to the different timing of PCD : early PCD group(patients who would receive PCD treatment within 2 weeks)and late PCD group(patients who would receive PCD treatment after 2weeks).The following data were collected for patients: including gender,age,and etiology(biliary pancreatitis,Alcoholic pancreatitis,hyperlipidemic pancreatitis and uncommon factors);time from disease onset to PCD treatment;disease severity scores(bedside index for severity in acute pancreatitis,pancreatitis activity scoring system,CT severity index),inflammatory indicators(white blood cells,procalcitonin,c-reactive protein,interleukin-6,interleukin-8,tumor necrosis factor-α),the number of cases of abdominal hypertension;disease severity scores on the two weeks after admission(bedside index for severity in acute pancreatitis,pancreatitis activity scoring system,CT severity index);microbiological culture results of drainage fluid of the third week;PCD-related indicators(PCD indications,the number of PCDs,PCD-related complications);further interventions indicators(including further interventions rate,the number of cases of sinus tract endoscopy necrosectomy,the number of open percutaneous necrosectomy);inflammatory indicators(white blood cells,procalcitonin,c-reactive protein,interleukin-6,interleukin-8,tumor necrosis factor-α)on the day of PCD and 7 days after PCD.clinical outcomes(fatality rate,the number of cases of systemic complications such as deep venous thrombosis,intestinal obstruction,gastrointestinal perforation,pulmonary infections,acute respiratory distress syndrome,the number of cases of new onset of organ failure,hospitalization time).The clinical data were collected and analyzed with statistical tools,aiming to explore the differences in the clinical efficacy of ultrasound-guided percutaneous catheter drainage performed at early versus late stages of SAP.Results:There was no significant differences in gender,age,etiology,interval from AP onset to admission between the two groups(P>0.05).There was no significant differences in disease severity scores(bedside index for severity in acute pancreatitis,pancreatitis activity scoring system,CT severity index),inflammatory indicators(c-reactive protein,interleukin-6,interleukin-8,tumor necrosis factor-α),and abdominal hypertension between the two groups(P>0.05).The disease severity scores(bedside index for severity in acute pancreatitis,pancreatitis activity scoring system,CT severity index)on the two weeks after admission in the early PCD group was significantly fewer than the late PCD group(P<0.05);The rate of positive drainage fluid culture of the third week in the early PCD group was significantly fewer than the late PCD group(P<0.05);The number of enterococcus faecalis cases in the early PCD group were significantly less than the late PCD group(P<0.05).There was no significant differences in indication of PCD(suspected infection)between the two groups(P>0.05),The number of abdominal hypertension cases in early PCD group were more than that in early PCD group(P<0.05),The number of parcel formation cases in late PCD group were more than that in early PCD group(P<0.05);the early group required significantly less times of PCD than the late PCD group(P<0.05);There was no significant difference in the complication rate of PCD between the two groups(P>0.05).The further interventions rate in the early PCD group was significantly lower than that in the late PCD group(P<0.05);The rate of sinus tract endoscopy necrosectomy(STEN)in the late PCD group was significantly higher than that in early PCD group(P<0.05);There was no significant difference in the proportion of patients receiving open percutaneous necrosectomy(OPN)between the two groups(P>0.05).At 7 days after PCD treatment,the white blood cells,procalcitonin,c-reactive protein,interleukin-6,interleukin-8 were decreased in two groups(P<0.05).The fatality rate in the early PCD group was lower than that in the late PCD group(P<0.05);The number of cases of deep venous thrombosis,intestinal obstruction,pulmonary infections,acute respiratory distress syndrome were significantly fewer in the early PCD group than in the late PCD group(P<0.05);There were more new onsets of organ failure(≥2)in the late PCD group than in the early PCD group(P<0.05);The length of hospital stay in the early PCD group was significantly shorter than the late PCD group(P<0.05).Conclusions:1.Early ultrasound-guided PCD treatment can timely draining effusion or necrotic matter.It may reduce abdominal pressure,improve intestinal blood supply,intestinal barrier function and other mechanisms,prevent intestinal bacteria from migrating,and thus reduce the incidence of abdominal infection.2.Early ultrasound-guided PCD treatment has fewer times of puncture catheterization and lower further interventions rate.It is closely related to the clearance of inflammatory effusion or necrotic matter by PCD and the quality of effusion or necrotic matter.It is beneficial to reduce multiple catheterization and further interventions in the later stage.3.Early or late Ultrasound-guided PCD can improve inflammatory state of the body.Early PCD treatment can significantly lower fatality rate,onset of organ failure and systemic complication rate,shorten the length of hospital stay,and effectively improve clinical outcomes of SAP patients.