Infected necrotizing pancreatitis
Conditions
Interventions
Early intervention group:Early open necrosectomy after 30 days from the onset
Sponsors
Jinling Hospital, Nanjing University
Eligibility
Sex/Gender
All
Age
18 Years to 70 Years
Inclusion criteria
Inclusion criteria: 1. Less than 30 days from onset to admission; 2. Adult patients (18-70 years old); 3. Meet the diagnostic criteria of IPN (at the same time meet the following three) : 1) Meet AP diagnostic criteria (=2 items) : a. Persistent pain in the upper abdomen; b. Serum amylase and/or lipase are 3 times higher than the normal upper limit; c. Typical findings of abdominal imaging (pancreatic edema/necrosis or peripancreatic effusion); 2) Enhanced CT confirmed the presence of parenchymal or peripancreatic necrosis 3) The drainage fluid culture of pancreatic necrotic tissue was positive in etiology; 4. Receive minimally invasive drainage treatment (including percutaneous drainage, endoscopic transgastric or transduodenal papillary drainage, etc.); 5. Early risk of minimally invasive treatment failure: the prediction model calculated that the probability of minimally invasive treatment failure was > 50%; The SOFA score increased by more than 2 points compared with the last minimally invasive drainage or continued organ function did not relieve. 6. Subjects voluntarily participate in the study and have signed informed consent.
Exclusion criteria
Exclusion criteria: 1. The patient had undergone open necrosectomy before admission; 2. Indications for open surgery are clearly present within 30 days of onset (any of the following conditions occur) : 1) Combined with abdominal compartment syndrome, abdominal pressure =30 mmHg(1 mmHg=0.133 kPa) and progressive increase of abdominal pressure after non-surgical treatment; 2) There is active bleeding in IPN, which cannot be stopped after non-surgical treatment and is life-threatening; 3) Digestive tract fistula that cannot be adequately drained; 4) Septic shock progressive aggravation. 3. Patients and their families give up treatment due to economic reasons; 4. Have serious cardiovascular, respiratory, kidney or liver diseases.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| All-Cause Mortality; | — |
Secondary
| Measure | Time frame |
|---|---|
| Major complication incidence;Total number of days of organ failure;The number of rescue operations and the total number of open operations;Incidence of incisional hernia;Length of stay in ICU and hospital;Total cost in-hospital ; | — |
Countries
China
Contacts
Public ContactWeiqin Li
Jinling Hospital, Nanjing University
Outcome results
None listed