Lesser sac and both sides of the retroperitoneal space opening lavage with regional arterial perfusion for the treatment of early severe acute pancreatitis

Objective To investigate the effectiveness of lesser sac and both sides of the retroperitoneal space opening lavage with regional arterial perfusion for the treatment of early severe acute pancreatitis (SAP).Methods The clinical data of 26 cases of early SAP who underwent lesser sac and both sides of the retroperitoneal space opening lavage with regional arterial perfusion from 2003 to 2011 were retrospectively evaluated in Department of Pancreatic Surgery,Jiaozuo People's Hospital.Results At 1st day after operation,the body temperature,pulse,respiratory rate,APACHE Ⅱ score,abdominal pressure,central venal pressure (CVP),blood glucose,WBC,PaCO2,triglycerides,creatinine were (37.4±0.9) ℃,(104 ± 13)/min,(21 ±5)/min,(12.3 ±4.0),(11.8 ±2.1)cm H2O (lcm H2O =0.098 kPa),(18.2 ±0.6) cm H2O,(7.7 ±0.6)mmol/L,(9.54±2.80) × 109/L,(42.40±4.72)mm Hg (1 mm Hg=0.133 kPa),(13.83 ± 1.01) mmol/L,(215.6±3.5) μmol/L,which were significantly lower than those before operation,and the difference between the two groups was statistically significant (P ＜0.01).At 1st day after operation,urine output,PaO2,mean arterial pressure (MAP) were (90.6 ± 4.5) ml/h,(88.15 ± 3.02) mmHIg,(84.8 ± 3.4) mmHg,which were significantly higher than those before operation,and the difference between the two groups was statistically significant (P＜0.01).ARDS,acute renal failture,shock,SIRS occurred in 22 (84.6％),15(57.6％),14(53.8％) and 22(84.6％) cases,which were decreased to 2(7.6％),1 (3.8％),1 (3.8％) and 3 (11.5％) after treatment.Postoperative intestinal fistula,pancreatic fistula,intraperitoneal bleeding,fungal infection occurred in 2 (7.6％),3 (11.5％),2 (7.6％),12 (46.2％) patients.The cure rate and mortality rates was 92.3％ (24/26) and 7.7％ (2/26) respectively.Conclusions Lesser sac and both sides of the retroperitoneal space opening lavage with regional arterial perfusion are effective for the treatment of early SAP,which can significantly improve survival and reduce mortality. Key words: Pancreatitis, acute necrotizing;  Decompression, surgical;  Drainage;  Peritoneal lavage;  Infusions, paventeral