Results of surgical treatment of necrotizing pancreatitis

作者：Hans G. Beger, Wolfgang Krautzberger, R. Bittner, Sylvia Block, Markus Wolfgang Büchler · 发表于：World Journal of Surgery · 年份：1985 · DOI：10.1007/bf01655406 · 被引用次数：160 · 研究领域：Pancreatitis Pathology and Treatment、Abdominal vascular conditions and treatments、Kawasaki Disease and Coronary Complications

Abstract In 205 patients with necrotizing pancreatitis, surgery was carried out following failure of medical treatment. Intraoperatively, according to the size of the necrotic area and the weight of the surgically removed necrotic tissue, 79 patients showed a limited pancreatic necrosis, and 126 patients an extended necrotizing process. In 40.4% of 138 patients with bacteriological reports, a bacterial contamination of the pancreatic necrosis was found. The main objective of surgical management was the removal of the necrotic tissue. This was performed with 2‐way drainage and postoperative continuous peritoneal and/or local lavage, in a smaller group of patients with inner drainage of the necrosis cavity, and in a few patients with drainage alone. The overall hospital mortality rate was 24.4%. The lowest mortality was achieved in patients treated with necrosectomy and postoperative continuous local lavage (6.0%). In patients with necrosis of approximately 30% of the pancreas, mortality was lower (7.6%) than in patients with a 50% necrosis (24.0%) or in patients with a subtotal/total necrosis (51.0%) (p<0.0001). Formation of extrapancreatic necrosis resulted in a significantly increased mortality rate (p<0.02). In patients with bacterially contaminated necrosis, a mortality rate of 32.1% was found, whereas in patients with a sterile necrosis, mortality was down to 9.8% (p<0.01). Based on the results of this study, we conclude that the clinical course of necrotizing pancreatiti...