A step-up drainage combined with thermostatic lavage in the management of infected pancreatic necrosis

Objective To investigate the safety and efficacy of a step-up drainage combined with thermostatic lavage in the management of severe acute pancreatitis complicated with infected pancreatic necrosis. Methods From January 2014 to July 2017, 100 cases of severe acute pancreatitis complicated with infected pancreatic necrosis admitted to our hospital were prospectively collected. All patients were randomly (random number) assigned into the observation group and control group with 50 cases in each group. The patients in both groups were given a step-up drainage. Moreover, patients in the observation group received lavage under constant temperature (30-35 °C) while the patients in the control group were at room temperature. The clinical prognosis of the two groups was observed. Results When compared with the control group, patients in the observation group got a lower rate of new onset renal injury (16.00% vs 34.00%, P=0.038); a lower rate of new onset gastrointestinal dysfunction (12.00% vs 28.00%, P=0.046); a reduced mechanical ventilation time[ (14.82±7.78)vs (18.64±8.12)d, P=0.018]; a decreased continuous blood filtration [(12.98±6.20) vs (18.56±10.92)d, P=0.002]; and a shorter hospital duration [(43.28±10.72) vs (50.82±12.74) d, P=0.002]. No significant difference was found in the APACHEⅡscore between the two groups at admission and at the time of puncture [(9.88±2.40) vs (9.46±2.35), P=0.378 and (10.30±3.07 vs (10.54±2.96), P=0.692]. At 7 and 14 days after the puncture, the APACHE II score in the observation group was significantly lower than that in the control group [(9.32±2.49) vs (10.56±2.80), P=0.021 and (6.20±2.54 vs (8.42±2.48), P<0.01]. Conclusions A step-up drainage combined with constant temperature lavage can reduce the incidence of new renal failure and gastrointestinal dysfunction in infected pancreatic necrosis patients and improve the clinical prognosis of the patients. Key words: Thermostatic lavage; Severe acute pancreatitis; Organ failure