Retrospective Analysis Of Efficacy And Prognosis Of Percutaneous Catheter Drainage In Patients With Acute Pancreatitis Having Sterile Fluid Collections

Objective:To investigate the efficacy and prognosis of percutaneous catheter drainage(PCD)in management of sterile fluid collections in patients with moderately severe and severe acute pancreatitis(MSAP/SAP)Methods:In a retrospective study between Jan 2010 and Dec 2019,126 patients with MSAP/SAP having sterile fluid collections were enrolled.One group was initially treated with PCD as PCD group,including thirty-three patients,and the other group with conservative management as non-PCD group,ninety-three patients included.To compare the rate of secondary peripancreatic infection and further surgery,and the efficacy and prognosis between two groups after therapy.To evaluate the clinical effect of PCD in patients with MSAP/SAP having sterile fluid collections.Results:PCD was used in 33 patients of which 23/33(69.7 %)occurred secondary peripancreatic infection,and 24/33(72.7%)need surgery after PCD.Average days of hospital stay in PCD group was 46 days,while 32 days in non-PCD group.93 patients in non-PCD group of which 23/93(24.7 %)occurred secondary peripancreatic infection,and 36/93(38.7 %)need surgery after conservative management.Compared with the non-PCD group,patients in PCD group have a higher risk in secondary pancreatic infection(69.7% vs 24.7%,P<0.05),further surgery after therapy(72.7% vs38.7%,P<0.05)and longer days of hospital stay(46 d vs 32 d,P<0.05).Secondary pancreatic infection was occurred in 23/33 patients in PCD group of which 20 need surgery after PCD,including 2 were treated with ileostomy due to colonic fistula,1 was treated with laparoscopic external drainage due to pancreatic pseudocyst rupture and 16 were treated with laparoscopic pseudocystoenterostomy due to peripancreatic abscess,other 3 did not need surgery after PCD.1 deathed from multiple organ failure.10 patients without secondary pancreatic infection in PCD group of which 4 need surgery after PCD,all of them were treated with laparoscopic Roux-en-Y cystojejunostomy due to compression symptoms caused by large pancreatic pseudocyst(﹥6cm),other 6 did not need surgery after PCD.Secondary pancreatic infection was occurred in 23/93 patients in non-PCD group of which all of them need further surgery,including 2 was treated with ileostomy due to colonic fistula,and 21 were treated with laparoscopic pseudocystoenterostomy due to peripancreatic abscess.1 deathed from severe abdominal infection and pulmonary infection after operation.70 patients without secondary pancreatic infection in non-PCD group of which 13 need surgery,all of them were treated with laparoscopic Roux-en-Y cystojejunostomy(2 were complicated by pancreatic pseudocyst hemorrhage and 11 were due to compression symptoms caused by large pancreatic pseudocyst(﹥6cm)),other 56 did not need surgery.1 deathed from failure of respiration.Compared with patients without secondary pancreatic infection in PCD group,the following characteristics were significantly higher in patients with secondary pancreatic infection:APACHE II(7 vs 5,P<0.05),MCTSI(6 vs5,P<0.05),BISAP score(2 vs 1,P<0.05),Ranson score(3 vs 2,P<0.05),the risk of further surgery(87% vs 40%,P<0.05)and average days of hospital stay(57 d vs 21 d,P<0.05).Conclusion:Compared with conservative management,PCD as initially treatment have a higher risk of secondary peripancreatic infection and further surgery after therapy,Early intervention of PCD in the management of sterile fluid collections in patients with moderately severe and severe acute pancreatitis does more harm than good,it may further increase the risk of secondary peripancreatic infection and further surgery.