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- 저자 : ( Kyoung Hoon Rree ) (검색결과 1 건)
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( Kyoung Hoon Rree ),( Dong Wan Seo ),( Ji Young Kim ),( Tae Yoon Lee ),( Sang Soo Lee ),( Sung Koo Lee ),( Myung Hwan Kim ) 대한소화기학회 2007 SIDDS Vol.9 No.-
Background/Aims: Necrotizing pancreatitis complicated with infection (IPN) is the main risk factor of morbidity and mortality in severe acute pancreatitis (SAP), and immediate surgical debridement of the septic focus have been widely accepted for this codition. However, surgical inter vention in systemic inflammatory state also contains a high mortality by itself and better treatment strategy is required. Our aim was to evaluate the efficacy of intensive non-surgical treatment in patients with SAP including INP. Methods: 101 patients [age (median, range, years): 51, 19-85; gender (M:F): 80:21] with SAP with necrosis (APACHE II score≥8, or Ranson`s score≥3, and pancreatic necrosis on CT scan) were retrospectively analyzed. IPN was confirmed by FNA. Intensive medical treatment including prophylactic antibiotics coverage, fluid resuscitation, organ preserving supportive measures, and percutaneous (PCD) or endoscopic drainage (ED) were applied. Surgery was conducted when there was no clinical improvement after the initial intensive medical treatment or immediate acute complications such as bowel perforation and panperitonitis were developed. Results: Mean values of Ranson`s score, APACHE II, and CT severity index were 4.86±1.88, 11.44±5.3, and 8.16±1.80, respectively. Among 101 patients, FNA and drainage procedures was performed in 51 patients, 47 PCD, 3 ED, and 1 combined PCD and ED. Forty-three patients received antibiotics only. Twenty-two patients required surgical intervention, 15 from drainage group and 7 from antibiotics only group. Microorganisms were identified in 38 patients and were treated with 23 PCD, 11 surgery with external drainage, 1 surgery only. The mortality rates of intensive medical treatment group and surgically treated group in SAP (INP) patients were 12.7% and 22.7% (4.3% and 16.6%), respectively. Conclusions: Intensive medical treatment comprising PCD and/or ED for INP showed favorable outcome in a substantial portion of patients.
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