Analysis of curative effect of active percutaneous puncture drainage in the treatment of severe acute pancreatitis complicated with acute necrotic accumulation

doi:10.3877/cma.j.issn.1674-3946.2024.06.021

Abstract

Abstract:

Objective

To analyze the clinical efficacy of active percutaneous catheter drainage (PCD) in the treatment of severe acute pancreatitis (SAP) complicated by acute necrotic accumulation (ANC).

Methods

Clinical data of 23 patients who received active PCD from October 2020 to October 2021 and 47 patients who received standard PCD from September 2018 to September 2020 were retrospectively analyzed. SPSS 23.0 statistical software was used to analyze the data. The measurement data of normal distribution are represented by (), and independent sample t test is adopted. χ² test was used to analyze the classified data. Fisher exact probability method is used for comparative analysis of small sample categorical variables. P<0.05 indicated that the difference was statistically significant.

Results

There were no significant differences in demographic data, etiology and severity of pancreatitis, indications of PCD and complications related to PCD between the two groups (P>0.05). Patients in standard PCD group had longer hospital stay, more patients required ICU monitoring and longer ICU monitoring (P<0.05). There was no significant difference in the number of patients with persistent organ failure reversal (78.6% vs. 56.0%, P=0.190), mortality and operation rate between the two groups (P>0.05). More patients in the active PCD group had upgraded drainage tubes (P=0.030), more drainage tubes were inserted (P=0.048), and the drainage tube size was larger (P<0.01). In the active PCD group, the APACHE score decreased more (P<0.01), the drainage tube was more smooth (P<0.01), and the drainage tube could be removed earlier (P=0.012).

Conclusion

Active PCD is an effective drainage method for ANC and can effectively treat ANC.

Key words: Severe Acute Pancreatitis, Acute Necrotic Accumulation, Percutaneous Catheter Drainage

Junqiang Dang, Yanling Yang, Qingqiang Wang, Lin Shang, Lei Zhu, Hongjun Xiang. Analysis of curative effect of active percutaneous puncture drainage in the treatment of severe acute pancreatitis complicated with acute necrotic accumulation[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 671-674.

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References 10

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组别	例数	女性（例）	年龄（岁，）	病因（例）	入院APACHEⅡ（分，）
组别	例数	女性（例）	年龄（岁，）	A/B/C/D	入院APACHEⅡ（分，）
主动PCD组	23	10	55.7±14.7	7/9/4/3	15.5±3.0
标准PCD组	47	19	50.6±14.2	14/18/9/6	14.8±3.2
t/χ²值		0.060	1.410	0.003	0.090
P值		0.810	0.160	0.960	0.370
组别	例数	WBC计数（×10⁹/L, ）	需手术治疗（例）	CTSI（）
主动PCD组	23	15.5±3.9	3	9.3±2.1
标准PCD组	47	15.4±3.7	13	8.9±1.9
t/χ²值		0.060	-	0.740
P值		0.960	0.170	0.460

组别	例数	女性（例）	年龄（岁，）	病因（例）	入院APACHEⅡ（分，）
组别	例数	女性（例）	年龄（岁，）	A/B/C/D	入院APACHEⅡ（分，）
主动PCD组	23	10	55.7±14.7	7/9/4/3	15.5±3.0
标准PCD组	47	19	50.6±14.2	14/18/9/6	14.8±3.2
t/χ²值		0.060	1.410	0.003	0.090
P值		0.810	0.160	0.960	0.370
组别	例数	WBC计数（×10⁹/L, ）	需手术治疗（例）	CTSI（）
主动PCD组	23	15.5±3.9	3	9.3±2.1
标准PCD组	47	15.4±3.7	13	8.9±1.9
t/χ²值		0.060	-	0.740
P值		0.960	0.170	0.460

参数	例数（n=70）	主动PCD组（n=23）	标准PCD组（n=47）	t/χ²值	P值
PCD指征[例（%）]
疑似感染	24(34.3)	7(30.4)	17(36.2)	0.230	0.640
持续器官衰竭	39(55.7)	14 (60.9)	25(53.2)	0.370	0.540
压迫症状	7(10.0)	2(8.7)	5(10.6)	-	1.000
升级PCD [例（%）]	36(51.4)	16(69.6)	20(42.6)	4.510	0.030
置入新的PCD[例（%）]	28(40.0)	13(56.5)	15(31.9)	3.900	0.048
PCD最大导管（Fr，）	15.1±4.6	19.3±4.8	13.0±2.7	7.020	<0.01
持续引流的天数（d，）	25.0±6.5	22.2±5.5	26.3±6.5	-2.590	0.012
^a导管通畅[根（%）]	91 (87.5)	43 (100)	48 (78.7)	-	0.001
APACHE Ⅱ入院（A）（分，）	15.0±3.1	15.5±3.0	14.8±3.2	0.900	0.370
APACHE Ⅱ PCD引流14 d后（B）（分，）	9.2±2.7	7.8±2.1	9.9±2.7	-3.230	0.002
APACHE Ⅱ减少值（A-B）（分，）	5.8±2.6	7.7±2.1	4.9±2.4	4.860	<0.001
^b持续性器官衰竭逆转数[例（%）]	25/39(64.1)	11/14(78.6)	14/25(56.0)	-	0.190
EPF [例（%）]	18 (25.7)	5 (21.7)	13（27.7）	0.280	0.590
PCD相关出血[例（%）]	6 (8.6)	2 (8.7)	4 (8.5)	-	1.000
住院时间（d，）	30.7±7.4	28.9±5.1	32.3±7.0	-2.090	0.040
需入住ICU 监护[例（%）]	32(45.7)	6(26.1)	26(55.3%)	5.320	0.020
ICU 监护时间（d，）	11.8±4.7	8.0±2.2	12.3±4.8	-2.100	0.040
住院期死亡[例（%）]	9(12.9)	3(13.0)	6(12.8)	-	1.000

参数	例数（n=70）	主动PCD组（n=23）	标准PCD组（n=47）	t/χ²值	P值
PCD指征[例（%）]
疑似感染	24(34.3)	7(30.4)	17(36.2)	0.230	0.640
持续器官衰竭	39(55.7)	14 (60.9)	25(53.2)	0.370	0.540
压迫症状	7(10.0)	2(8.7)	5(10.6)	-	1.000
升级PCD [例（%）]	36(51.4)	16(69.6)	20(42.6)	4.510	0.030
置入新的PCD[例（%）]	28(40.0)	13(56.5)	15(31.9)	3.900	0.048
PCD最大导管（Fr，）	15.1±4.6	19.3±4.8	13.0±2.7	7.020	<0.01
持续引流的天数（d，）	25.0±6.5	22.2±5.5	26.3±6.5	-2.590	0.012
^a导管通畅[根（%）]	91 (87.5)	43 (100)	48 (78.7)	-	0.001
APACHE Ⅱ入院（A）（分，）	15.0±3.1	15.5±3.0	14.8±3.2	0.900	0.370
APACHE Ⅱ PCD引流14 d后（B）（分，）	9.2±2.7	7.8±2.1	9.9±2.7	-3.230	0.002
APACHE Ⅱ减少值（A-B）（分，）	5.8±2.6	7.7±2.1	4.9±2.4	4.860	<0.001
^b持续性器官衰竭逆转数[例（%）]	25/39(64.1)	11/14(78.6)	14/25(56.0)	-	0.190
EPF [例（%）]	18 (25.7)	5 (21.7)	13（27.7）	0.280	0.590
PCD相关出血[例（%）]	6 (8.6)	2 (8.7)	4 (8.5)	-	1.000
住院时间（d，）	30.7±7.4	28.9±5.1	32.3±7.0	-2.090	0.040
需入住ICU 监护[例（%）]	32(45.7)	6(26.1)	26(55.3%)	5.320	0.020
ICU 监护时间（d，）	11.8±4.7	8.0±2.2	12.3±4.8	-2.100	0.040
住院期死亡[例（%）]	9(12.9)	3(13.0)	6(12.8)	-	1.000

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