Multiple Minimally Invasive Therapy and Individualized Treatments Combination for Patients with Severe Acute Pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YAO Xinmin , LI Yuntao , HUANG Dequan , CAO Yang , ZHANG Shu , YANG Yicun , HUANG Jiangtao , YU Lan , XIAO Yuqing

Department of General Surgery, The Third People’s Hospital of Chengdu City, Chengdu 610031, China;

Corresponding author：

Keywords：

Severe acute pancreatitis; Multiple minimally invasive therapy; Combined; Individualized treatment

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Objective To evaluate the efficacy of multiple minimally invasive therapy and individualized treatments combination in severe acute pancreatitis. Methods The data of sixty-seven patients with severe acute pancreatitis between September 1998 and October 2008 undergoing multiple minimally invasive therapy and individualized treatments were analyzed retrospectively. The changes of APACHE Ⅱ score, CT score, WBC count, total bilirubin, AST, blood glucose, amylase, lypase, C-reactive protein, tumor necrosis factor-α, blood urea nitrogen, creatinine, and oxygenation index (PaO2/FiO2) were observed and compared between before and after treatment. Time of abdominal pain relieved, laparotomy rate, mortality rate, recovery rate, hospital stay, and cost of hospitalization were also observed. Results All the detected indexes improved significantly after treatments compared with those before treatments （P lt;0.001）. Time of abdominal pain relieved was (20.17±14.16) h. Laparotomy rate was 6.0% （4/67）. Mortality rate was 7.5% （5/67）. Recovery rate was 92.5% （62/67）. Hospital stay was (30.85±28.37) d and cost of hospitalization was (59 295.78±34 564.44) yuan. Conclusions Multiple minimally invasive therapy and individualized treatments for cases of severe acute pancreatitis with different causes, course, severity of disease, and complications, could significantly improve the clinical indexes and recovery rate of severe acute pancreatitis.

Citation： YAO Xinmin,LI Yuntao,HUANG Dequan,CAO Yang,ZHANG Shu,YANG Yicun,HUANG Jiangtao,YU Lan,XIAO Yuqing,PENG Qiusheng,PU Guangchun,XU Chiwei,GONG Rong. Multiple Minimally Invasive Therapy and Individualized Treatments Combination for Patients with Severe Acute Pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(6): 586-590. doi: Copy

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2.	Knaus WA, Draper EA, Wagner DP, et al. APACHE Ⅱ: a severity of disease classification system [J]. Crit Care Med, 1985; 13(10): 818-829.
3.	于澜, 姚欣敏, 胡先典，等. 经内镜治疗急性胆源性胰腺炎30例报道 [J]. 中国普外基础与临床杂志, 2007; 14(4): 396-398.
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11.	黄江涛, 姚欣敏, 曹扬，等. 体外药盒置入胰腺区域动脉灌注治疗重症急性胰腺炎临床研究 [J]. 实用医院临床杂志， 2009； 6（2）: 87-88.
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13.	罗静，彭秋生，姚欣敏. CT引导下经皮穿刺抽液引流诊治急性胰腺炎局部并发症（附24例报告） [J]. 华西医学, 2007; 22(4): 735-737.
14.	姚欣敏, 于澜, 张抒，等. CT引导下经皮穿刺诊治重症急性胰腺炎局部并发症的临床研究(附43例报道) [J]. 中国普外基础与临床杂志, 2008; 15(8): 560-563.
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19.	孔瑞, 孙备. 重症急性胰腺炎微创治疗的研究进展 [J]. 国外医学外科学分册, 2005; 32(6): 426-429.
20.	Kraas E, Frauenschuh D. Surgery of the gallbladder and bile ducts by minimally invasive surgery [J]. Chirurg, 2001; 72(4): 378-388.
21.	Hayashi J, Kawarada Y, Isaji S, et al. Therapeutic effects of continuous intraarterial antibiotic infusion in preventing pancreatic infection in experimental acute necrotizing pancreatitis [J]. Pancreas, 1996; 13(2): 184-192.
22.	Takagi K, Isaji S. Therapeutic efficacy of continuous arterial infusion of an antibiotic and a protease inhibitor via the superior mesenteric artery for acute pancreatitis in an animal model [J]. Pancreas, 2000; 21(3): 279-289.
23.	Takeda K. Continuous regional arterial infusion of protease inhibitor and antibiotic for severe acute pancreatitis [J]. N Nippon Rinsho, 2004; 62(11): 2101-2107.
24.	Banerjee AK, Steele RJ. Current views on the pathophysiology of acute biliary pancreatitis [J]. Gut, 1995; 36(6): 803-805.
25.	Espa a-Gómez MN, Pantoja JP, Herrera MF. Laparoscopic surgery of pancreas [J]. Rev Gastroenterol Mex, 2004; 69 Suppl 1: 84-90.
26.	Bagnenko SF, Tolstoǐ AD, Rukhliada NV, et al. Minimally invasive technologies in the treatment of severe forms of acute pancreatitis at various periods of the disease [J]. Vestn Khir Im I I Grek, 2002; 161(6): 30-34.

1. 中华医学会外科学分会胰腺外科学组. 重症急性胰腺炎诊治指南 [J]. 中华外科杂志, 2007; 45(11)： 727-729.
2. Knaus WA, Draper EA, Wagner DP, et al. APACHE Ⅱ: a severity of disease classification system [J]. Crit Care Med, 1985; 13(10): 818-829.
3. 于澜, 姚欣敏, 胡先典，等. 经内镜治疗急性胆源性胰腺炎30例报道 [J]. 中国普外基础与临床杂志, 2007; 14(4): 396-398.
4. 于澜, 姚欣敏, 胡先典，等. 经内镜治疗急性胆源性胰腺炎的临床研究 [J]. 四川医学， 2009; 30（5）: 707-709.
5. 刘大为. 外科重症病人的血液净化治疗 [J]. 中国实用外科杂志, 2008; 28(6): 427-428.
6. 杜斌. 非肾性疾病的血液滤过适应证和治疗目标探讨 [J]. 中国实用外科杂志, 2008; 28(6): 431-433.
7. 汤耀卿. 重症急性胰腺炎的血液滤过治疗 [J]. 中国实用外科杂志, 2008; 28(6): 443-445.
8. 姚欣敏, 刘牧, 李云涛，等. 早期反复间断血滤治疗重症急性胰腺炎的临床研究 [J]. 中国普外基础与临床杂志, 2008; 15(5): 352-357.
9. 姚欣敏，黄江涛. 区域动脉灌注治疗重症急性胰腺炎 [J]. 四川医学, 2002; 23（6）: 602-603.
10. 张抒, 罗静, 姚欣敏，等. 体外药盒置入胰腺区域动脉灌注治疗重症急性胰腺炎30例临床分析 [J]. 中国普外基础与临床杂志, 2003; 10(6): 545-547.
11. 黄江涛, 姚欣敏, 曹扬，等. 体外药盒置入胰腺区域动脉灌注治疗重症急性胰腺炎临床研究 [J]. 实用医院临床杂志， 2009； 6（2）: 87-88.
12. 罗静，彭秋生，姚欣敏. CT引导下经皮穿刺引流诊治急性胰腺炎局部并发症-附23例报告 [J]. 胰腺病学, 2007; 7 (4): 251-252.
13. 罗静，彭秋生，姚欣敏. CT引导下经皮穿刺抽液引流诊治急性胰腺炎局部并发症（附24例报告） [J]. 华西医学, 2007; 22(4): 735-737.
14. 姚欣敏, 于澜, 张抒，等. CT引导下经皮穿刺诊治重症急性胰腺炎局部并发症的临床研究(附43例报道) [J]. 中国普外基础与临床杂志, 2008; 15(8): 560-563.
15. 黄江涛, 胡先典. 腹腔镜下置管灌洗引流在重症急性胰腺炎早期治疗中的体会 [J]. 四川医学, 2007; 28(4): 419-421.
16. 许持卫，吕海波，周翔平. CT引导下经皮急性胰腺炎急性液体聚集穿刺置管引流术 [J]. 实用放射学杂志， 2008； 24（2）： 209-210，214.
17. Ricci F, Castaldini G, de Manzoni G, et al. Treatment of gallstone pancreatitis: six-year experience in a single center. [J]. World J Surg, 2002; 26(1): 85-90.
18. Isogai M, Yamaguchi A, Harada T, et al. Cholangitis score: a scoring system to predict severe cholangitis in gallstone pancreatitis [J]. J Hepatobiliary Pancreat Surg, 2002; 9(1): 98-104.
19. 孔瑞, 孙备. 重症急性胰腺炎微创治疗的研究进展 [J]. 国外医学外科学分册, 2005; 32(6): 426-429.
20. Kraas E, Frauenschuh D. Surgery of the gallbladder and bile ducts by minimally invasive surgery [J]. Chirurg, 2001; 72(4): 378-388.
21. Hayashi J, Kawarada Y, Isaji S, et al. Therapeutic effects of continuous intraarterial antibiotic infusion in preventing pancreatic infection in experimental acute necrotizing pancreatitis [J]. Pancreas, 1996; 13(2): 184-192.
22. Takagi K, Isaji S. Therapeutic efficacy of continuous arterial infusion of an antibiotic and a protease inhibitor via the superior mesenteric artery for acute pancreatitis in an animal model [J]. Pancreas, 2000; 21(3): 279-289.
23. Takeda K. Continuous regional arterial infusion of protease inhibitor and antibiotic for severe acute pancreatitis [J]. N Nippon Rinsho, 2004; 62(11): 2101-2107.
24. Banerjee AK, Steele RJ. Current views on the pathophysiology of acute biliary pancreatitis [J]. Gut, 1995; 36(6): 803-805.
25. Espa a-Gómez MN, Pantoja JP, Herrera MF. Laparoscopic surgery of pancreas [J]. Rev Gastroenterol Mex, 2004; 69 Suppl 1: 84-90.
26. Bagnenko SF, Tolstoǐ AD, Rukhliada NV, et al. Minimally invasive technologies in the treatment of severe forms of acute pancreatitis at various periods of the disease [J]. Vestn Khir Im I I Grek, 2002; 161(6): 30-34.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Multiple Minimally Invasive Therapy and Individualized Treatments Combination for Patients with Severe Acute Pancreatitis

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