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BACKGROUND/AIMS: Infection of pancreatic necrosis is one of the leading cause of death in patients with severe necrotizing pancreatits. Because of high mortality rate up to 50%, immediate surgical debridement including pancreatectomy is recommended. However, early surgical treatment still showed high mortality rate and better treatment strategy is required. This study was conducted to evaluate the outcomes of early intensive non-surgical treatments in patients with infected necrotizing pancreatitis. METHODS: This study was based on retrospective analysis of 71 patients with acute severe necrotizing pancreatitis (APACHE II score>or=8, or Ranson's score>or=3, and pancreatic necrosis on CT scan), who were admitted to medical center during past 16 years. Infection of pancreatic necrosis was confirmed by fine needle aspiration, and early intensive medical treatments comprised of prophylactic antibiotics coverage, fluid resuscitation, organ preserving supportive measures, and percutaneous catheter drainage were carried out. RESULTS: Among the enrolled patients, infections were suspected in 46 patients, but fine needle aspirations were done only in 32 patients. In 21 patients, infections of necrotic tissue were confirmed by bacteriology, while other 11 patients showed no evidence of bacterial growth. Of 21 patients with infected necrosis, initial surgical interventions were performed in 2 patients, while initial medical treatments were performed in 19 patients. The success rate of medical treatment group in infected necrotizing pancreatitis was 79% (15/19). The mortality rate of medical treatment group and surgical treatment group was 5% (1/19) and 50% (1/2). CONCLUSIONS: Early intensive medical treatment seems to be a good therapeutic strategy, even if the infection has developed in pancreatic necrosis. Further prospective randomized studies are required to confirm this finding.
Bacterial Infections/diagnosis/*prevention & control ; Humans ; Pancreatitis, Acute Necrotizing/complications/diagnosis/*therapy ; Retrospective Studies ; Treatment Outcome

9.The characteristic of severe acute pancreatitis and the selection of the therapeutic strategy.

Min WANG ; Zhi-wei XU ; Ruo-qing LEI ; En-qiang MAO ; Sheng CHEN ; Jian-cheng WANG ; Wei-ze WU ; Tian-quan HAN ; Yao-qing TANG ; Sheng-dao ZHANG

Chinese Journal of Surgery 2007;45(11):746-749

OBJECTIVETo investigate the relationship between the clinical character and therapeutic strategy and prognosis in severe acute pancreatitis.

METHODSFrom January 2001 to December 2005, 783 patients with SAP were treated. Therapeutic strategy was selected based on the preliminary scheme for diagnosis and treatment of severe acute pancreatitis by pancreatic surgery society of CMA. All the patients were divided into biliary group and non-biliary group, while 375 patients in biliary group, with 182 patients treated operatively and 193 patients treated nonoperatively; and 408 patients in non-biliary group, with 147 patients treated operatively and 261 patients treated nonoperatively.

RESULTSThere were 698 survivals, the overall survival rate was 89.1%. 357 survivals in the biliary SAP group, the survival rate was 95.0%, in which 171 survivals from operation treated cases, with the survival rate of 94.0%, and 186 survivals from non-operation treated cases, with the survival rate of 96.4%; 341 survivals in the non-biliary SAP group, the survival rate was 84.0%, in which 110 survivals from operation treated cases, with the survival rate of 74.8%, and 231 survivals from non-operation treated cases, with the survival rate of 88.5%. 48.3% patients of the survival group had organ dysfunction, and 18.3% patients had multiple organ dysfunctions, while 100% patients of the death group had organ dysfunction, and 97.6% patients had multiple organ dysfunction. Respiratory dysfunction was found to be the most common cause totally followed by nerve system dysfunction and shock, with the rates of 26.3%, 11.7% and 10.3%, respectively. Respiratory dysfunction, renal dysfunction and cardiac dysfunction are most commonly in death group, with the rate of 94.1%, 60.0% and 60.0%, respectively. The rate of fungi infection in the survival group and death group were 8.9% and 37.6%. The rates of alimentary tract fistula in the survival and death group were 0.9% and 14.1%, respectively.

CONCLUSIONSThe therapy aiming at the cause for biliary SAP and the operation aiming at infected pancreatic necrosis is helpful to improve curative rate; MODS is the main cause of death in severe acute pancreatitis. Respiratory dysfunction, renal dysfunction and cardiac dysfunction are high risk factors.

Female ; Humans ; Male ; Middle Aged ; Pancreatitis, Acute Necrotizing ; diagnosis ; mortality ; therapy ; Prognosis ; Retrospective Studies ; Survival Rate

10.Double filtration plasmapheresis in treatment of hyperlipidemic acute pancreatitis.

Ge ZHANG ; Jian FENG ; Qiu-ping XU ; Hai-ying HUANG

Journal of Zhejiang University. Medical sciences 2008;37(1):93-96

1.Surgically combined treatment of severe acute pancreatitis:status quo and thinking..

2.Improving the level of diagnosis and therapy to acute severe pancreatitis complicating with abdominal compartment syndrome.

3.The clinical course of severe acute pancreatitis depending on the timing of managements for different conditions.

4.Clinical importance of guideline for severe acute pancreatitis of China.

5.The guidelines interpretation for diagnosis and treatment of severe acute pancreatitis.

6.Therapeutic principles in treatment of severe acute pancreatitis.

7.Intensive Medical Treatments of Infected Severe Necrotizing Pancreatitis.

8.Outcome of Intensive Medical Treatments in Patients with Infected Severe Necrotizing Pancreatitis.

9.The characteristic of severe acute pancreatitis and the selection of the therapeutic strategy.

10.Double filtration plasmapheresis in treatment of hyperlipidemic acute pancreatitis.

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