临床时讯 ＞ 临床研究
美国一项研究显示，对于坏死性胰腺炎（NP）患者，应用影像学引导下的经皮穿刺置管引流（PCD）并不能降低其死亡率和器官衰竭发生率。相关论文发表于《外科档案》（Archives of Surgery）。
Arch Surg. 2009 Mar;144(3):261-5.
Impact of radiologic intervention on mortality in necrotizing pancreatitis: the role of organ failure.
Rocha FG, Benoit E, Zinner MJ, Whang EE, Banks PA, Ashley SW, Mortele KJ.
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
BACKGROUND: Our group previously reported that organ failure and mortality in necrotizing pancreatitis (NP) are not different between patients with infected and sterile necrosis. Since that report, management of this disease has evolved to include image-guided percutaneous catheter drainage (PCD) to improve morbidity and mortality. We evaluated the effect of PCD on mortality in NP. DESIGN: Retrospective analysis. SETTING: Tertiary care referral center. PATIENTS: A total of 689 consecutive patients treated for acute pancreatitis between 2001 and 2005, of whom 64 (9.3%) had pancreatic necrosis documented on contrast-enhanced computed tomography. MAIN OUTCOME MEASURES: Mortality and organ failure. RESULTS: In the 64 patients with documented NP, overall mortality was 16%. Thirty-six patients (56%) had organ failure according to the Atlanta classification. Compared with patients with sterile necrosis, those with infected necrosis did not have an increased prevalence of organ failure or increased need for intubation, pressors, or dialysis but had an increased mortality. Mortality in patients treated conservatively was 1 of 29 (3%); in those with PCD alone, 6 of 11 (55%); in those with PCD and surgery, 2 of 17 (12%); and in those with surgery alone, 1 of 7 (14%). All patients treated with PCD alone had organ failure, whereas 10 (59%) of those with PCD and surgery had organ failure. CONCLUSION: The use of PCD did not improve the mortality of NP among patients with organ failure.