Sa1914 ENDOSCOPIC DRAINAGE VS PRECUTANEOUS DRAINAGE,SURGERY AND RETROPERITONEAL PERCUTANEOUS NEPHROSCOPE NECROSECTOMY OF PANCRETIC FLUID COLLECTION(PFC): A RETROSPECTIVE STUDY OF 145 PATIENTS

Abstract

To compare and evaluate outcomes for patients of pancreatic fluid collection(PFC) undergoing endoscopic drainage(ED), percutaneous drainage(PD), surgery or retroperitoneal percutaneous nephroscope necrosectomy(RPN). Between January 2004 and December 2014, all patients of PFC in our hospital who received the above treatments were included. Rates of treatment success, adverse events, recurrence, length of hospital stay, and follow-up length for PFC disappeared were recorded retrospectively in all cases. Logistic regression analysis was performed to evaluate possible influence factors of treatment effect, and etiologic results of drainage fluid culture were summarized. In total, 145 patients were included in the study: 23 patients underwent ED(group A), 63 patients underwent PD[group B, which was divided into two sub groups B1(46 patients underwent PD alone) and B2(17 patients underwent PD and RPN)], 23 patients underwent surgery(group C and 36 patients underwent RPN( group D).Treatment success was significantly different between PD and surgery( 53.97% vs 95.65%, χ2=12.89 ， P ＜ 0.001), while it was similar among the five groups when group B was divided into two sub groups (B1 and B2) (χ2=4.8 ， P =0.308 ＞ 0.05).Meanwhile, RPN after failure of PD(group B2) significantly improved success rate according to group B(82.35% vs 53.97%,χ2=4.494 ， P =0.034 ＜ 0.05).Adverse events （ χ2=8.49 ， P =0.075 ＞ 0.05 ） and recurrence （ χ2=1.164 ， P=0.92 ） were similar among the five groups. Among the adverse events, the rate of give-up treatment attributed to MODS and mortality was totally 8.97%(13/145).Length of hospital stay, and follow-up length for PFC disappeared were significantly different among the five groups(Kruskal-Wallis test ， P ＜ 0.001). Particularly, follow-up length for PFC disappeared after surgery [29.5 (8.75∼41.75) days] was shorter compared with other four groups(P ＜ 0.05). Length of hospital stay in surgery and ED group was similar[10 （ 8∼14 ） vs 13 （ 5∼24 ） ,days].Logistic regression analysis indicated that baseline MODS before treatment influenced final treatment outcome [OR 12.281, 95%CI(3.246,44.026)].Drainage fluid culture suggested several common types of pancreatic pseudocyst pathogen infection: Escherichia coli (13.14%), Enterococcus (12.41%), Bauman Acinetobacter (10.22%), Klebsiella pneumoniae (8.76%), Candida albicans (8.03%), Pseudomonas aeruginosa (6.57%) and Staphylococcus aureus (5.11%). Compared to surgery and the minimally invasive surgical retroperitoneal approach(RPN), endoscopic drainage was associated with similar rates of treatment success, adverse events, recurrence and length of hospital stay. The follow-up length for PFC disappeared after surgery was shorter than other treatments. After failure of percutaneous drainage, retroperitoneal percutaneous nephroscope necrosectomy contributed to the improvement of success rate.