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Early versus delayed intervention in necrotizing acute pancreatitis complicated by persistent organ failure

Hepatobiliary & Pancreatic Diseases International 2022年第1期21卷 63-68页

作者： He Zhang Lin Gao Wen-Jian Mao Jie Yang Jing Zhou Zhi-Hui Tong Lu Ke Wei-Qin Li Medical School of Southeast University 87 DingjiaqiaoNanjing 210009China Center of Severe Acute Pancreatitis(CSAP) Department of General SurgeryJinling HospitalMedical School of Southeast UniversityNo.305 Zhongshan East RoadNanjing 210002China

Background:Current guidelines for the treatment of patients with necrotizing acute pancreatitis(NAP)recommend that invasive intervention for pancreatic necrosis should be deferred to 4 or more weeks from disease onset to allow necrotic collections becoming“walled-off”.However,for patients showing signs of clinical deterioration,especially those with persistent organ failure(POF),it is controversial whether this delayed approach should always be *** this study,we aimed to assess the impact of differently timed intervention on clinical outcomes in a group of NAP patients complicated by ***:All NAP patients admitted to our hospital from January 2013 to December 2017 were screened for potential *** were divided into two groups based on the timing of initial interven-tion(within 4 weeks and beyond 4 weeks).All the data were extracted from a prospectively collected ***:Overall,131 patients were included for *** them,100(76.3%)patients were in-tervened within 4 weeks and 31(23.7%)underwent delayed *** for organ failure prior to intervention,the incidences of respiratory failure,renal failure and cardiovascular failure were not signifi-cantly different between the two groups(P>0.05).The mortality was not significantly different between the two groups(35.0%vs.32.3%,P=0.83).The incidences of new-onset multiple organ failure(8.0%vs.6.5%,P=1.00),gastrointestinal fistula(29.0%vs.12.9%,P=0.10)and bleeding(35.0%vs.35.5%,P=1.00),and length of ICU(30.0 vs.22.0 days,P=0.61)and hospital stay(42.5 vs.40.0 days,P=0.96)were com-parable between the two ***:intervention within 4 weeks did not worsen the clinical outcomes in NAP patients compli-cated by POF.

关键词： Necrotizing acute pancreatitis Persistent organ failure Early intervention delayed intervention Clinical outcomes

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