The Clinical Studies Of Early Invasive Interventional Treatment For Severe Acute Pancreatitis

Objective To evaluate the method, effectiveness and safety of early selective continuous regional arterial infusion (CRAI) combined with nasal intestinal nutrition (EN) in the treatment to severe acute pancreatitis (SAP); at the same time to explore the CT guided percutaneous puncture catheter drainage (PCD) method and clinical value of treatment for severe acute pancreatitis.Methods50cases with severe acute pancreatitis between January2009and December2012in the intensive care unit (ICU) of the first hospital of lanzhou university after the clinical diagnosis of severe acute pancreatitis,26cases are enrolld strictly in this research. Patients were allocated into early selective continuous regional arterial infusion (CRAI) combined with nasal intestinal nutrition (EN) in the minimal invasive group which has24cases and early intravenous administration combined with nasal intestinal nutrition in the general treatment group which has x cases. The treatment group were from January2009to December2012, which have admitted on the basis of conventional treatment and have used early selective continuous regional arterial infusion (somatostatin,antibiotics, removal of endotoxin drugs and improving the microcirculation) immediately after the nasal-jejunal nutrition tube placement. The control group were from January2009to December2009, which have admitted on the basis of conventional treatment and have via peripheral intravenous drop or pump somatostatin, antibiotics, removal of endotoxin drugs and improve microcirculation in the treatment of severe acute pancreatitis patients. One of the32cases CT scanning include intrapancreas and peripancreatic has a extensive necrosis, liquefaction, and peripancreatic abscess and fibrous tissue formation of pancreas pseudocyst; Multirow helix CT guided position and the puncture point was safety, local anesthesia, intraoperative strict aseptic operation, routine cultivated fluid of drainage.Results Compared with the general treatment group(Ⅰ)the cure rate:the minimal invasive group (76.92%)(p<0.05);(2) the mortality rate:the minimal invasive group was none, the general treatment group was5cases (p<0.05);(3)the complications rate:the minimal invasive group (30.8%)(p<0.05);(4)the catheter drainage efficient rate:the minimal invasive group (92.3%)(p <0.05);(5)the abdominal pain relief time:the minimal invasive group(3.2±2.1)d (p<0.05);(6) the length of hospital stay:the minimal invasive group (21.8±6.6) d(P<0.05).Conclusions1. Early selective continuous regional arterial infusion combined with nasal intestinal nutrition in the treatment to SAP can improve the cure rate, remiss symptom quickly, shorter total hospitalization time, low costs hospitalization2. Early selective continuous regional arterial infusion combined with nasal intestinal nutrition in the treatment to SAP placement have fewer complications and reduce the secondary infection in severe acute pancreatitis.3. Early selective continuous regional arterial infusion immediately after nasal-jejunal nutrition tube placement advantage include small trauma, short time, low radiation dose, patient anguish small, reduce the patient’s moving again, worthy of clinical popularization.4. Early minimally invasive interventional combined treatment can effectively control the condition, inhibit the occurrence of complications and reduce systemic and local complications, more effective to reduce severity disease, and further limited lesions.For catheter drainage of under CT-guidance is more effective, worthy of clinical popularization and application.