Preliminary Study On The Efficacy Of Early Percutaneous Catheter Drainage For Severe Acute Pancreatitis With Sterile Pancreatic Fluid Collections

Objective:The aim of this study was to explore the efficacy of early ultrasound-guided percutaneous puncture and drainage on severe acute pancreatitis with sterile pancreatic fluid collections.Methods:The patients with severe acute pancreatitis who met the screening criteria in The Second Affiliated Hospital of Kunming Medical University from January 2015 to June 2022 were retrospectively analyzed.The included patients were divided into two groups according to whether to perform ultrasound-guided percutaneous catheter drainage(PCD)for sterile pancreatic fluid collections(PFCs)within one week after admission: sterile PFCs were subject to PCD(Group A)and were not subject to PCD at early stage(Group B).Compared the two groups:(1)General information on admission: age,sex,etiology,disease severity(APACHE II score,Marshall score,SOFA score)and organ failure.(2)Early clinical symptoms and signs(within 14 days):relief rate of abdominal pain,relief rate of intra-abdominal hypertension and days of moderate or above fever.(3)Clinical indexes of patients in the two groups at admission and on the 14 th day of admission:(1)Laboratory indexes: white blood cell(WBC),blood amylase,blood lipase,blood calcium,blood glucose;(2)inflammatory reaction related indexes: C-reaction protein(CRP),Interleukin-6(IL-6),Procalcitonin(PCT);(3)disease severity: APACHE Ⅱ score,Marshall score,SOFA score at the time of admission and on the 14 th day of admission.(4)The rate of new-onset organ failure,advanced surgery(according to the step-up strategy)and abdominal infection.(5)The rate of new organ failure,surgical advancement and mortality of patients with secondary infection and drainage after infection.All patients were followed up for at least half a year.The data were analyzed and processed by SPSS 27.0 software.Results:A total of 128 patients were included in the study,46 patients who successfully treated with PCD drainage within 1 week after admission were included in Group A.Other 82 patients who did not receive PCD drainage within 1 week after admission were included in group B,including 3 patients who failed PCD puncture.In group A,one of the 46 patients with PCD drainage had puncture bleeding,while the other 45 patients did not have clear PCD-related bleeding,gastrointestinal perforation and other complications.All patients were followed up for more than half a year without any loss of follow-up.(1)General data: There was no statistically significant difference between the two groups in terms of age,gender,etiology,disease severity,organ failure and other indicators.(2)Comparison of early clinical symptoms and signs(within 14 days): The remission rate of early abdominal pain(P=0.038)and intra-abdominal hypertension(P=0.041)in group A was higher than that in group B,and the difference was statistically significant.There was no statistically significant difference between the two groups in the time of moderate or above fever.(3)Comparison of clinical indexes between admission and the 14 th day of admission:(1)Comparison between groups: there was no statistically significant difference between the two groups in the relevant laboratory indicators,inflammatory reaction indicators and disease severity scores at admission;On the 14 th day of admission,the WBC(P=0.003),blood lipase(P=0.025),blood sugar(P=0.024),CRP(P=0.003),IL-6(P=0.043),PCT(P=0.017),APACHE Ⅱ score(P=0.015),Marshall score(P=0.045),SOFA score(P=0.017)of patients in Group A were significantly lower than those in Group B,and the blood calcium(P<0.001)was significantly higher than that in Group B,with statistically significant difference;There was no significant difference in blood amylase between group A and group B.(2)Intra-group comparison: Group A:the blood calcium level of patients in Group A after 14 days of admission was significantly higher than that at admission,and other relevant laboratory indicators,inflammatory reaction related indicators,and disease severity scores were significantly lower than that at admission,with a statistically significant difference(P<0.05).Group B: the blood amylase,lipase,CRP,IL-6,APACHE Ⅱ score,Marshall score and SOFA score of patients in Group B after 14 days of admission were significantly lower than at admission,and the blood calcium was significantly higher than the time of admission,the difference was statistically significant(P<0.05);There was no significant difference in the changes of WBC,blood glucose and PCT compared with the admission(P>0.05).(4)Comparison of new-onset organ failure rate,advanced rate and abdominal infection rate: group A had a lower re-order operation rate than group B(P=0.008),and the difference was statistically significant;There was no significant difference between the two groups in the rates of total new-onset organ failure,new respiratory,renal,circulatory system failure and abdominal infection(P>0.05).(5)Comparison of prognosis in the two groups with different sequences of drainage and infection: there were 12 patients with secondary infection after drainage in group A and 23 patients with drainage after infection in group B.There was no statistically significant difference between the two groups in mortality,reoperation rate and new-onset organ failure rate(P>0.05).Conclusion:For patients with severe acute pancreatitis and aseptic pancreatic fluid collections(>5cm),early percutaneous catheter drainage may be significant to relieve clinical symptoms and signs,to improve inflammatory reaction,delay organ failure,also not to increase the rate of abdominal infection.