ObjectiveTo investigate the effect of multidrug resistant (MDR) bacterial infection in clinical course of acute pancreatitis. MethodsThe medical records of 134 patients with a diagnosis of infected pancreatic necrosis in West China Hospital from Jan. 2003 to Jun. 2010 were reviewed. ResultsMDR microorganisms were found in 78 of the 134 patients. MDR group had higher rate of transferred patients than non-MDR group (38.5% vs. 10.7%, P=0.002). The intensive care unit admission rate was significantly higher in patients with MDR bacterial infections (48.7% vs. 26.8%, P=0.01). The mean intensive care unit stay was significantly longer in patients with MDR bacterial infections (20 days vs. 3 days, P<0.001). Mortality and total hospital stay was not significantly different in the patients with MDR infections vs. those without it (20.5% vs. 14.3%, P>0.05; 78 d vs. 55 d, P>0.05). ConclusionClinicians should be aware of the high incidence and impact of MDR infections in patients with acute necrotizing pancreatitis, especially in transferred patients.
Objectives To identify the effect of procalcitonin (PCT) on the choice of operating time for severe acute pancreatitis and assessment of postoperative complications by monitoring the level of serum PCT and recording the incidence of postoperative complications. MethodsNinety-three patients who underwent debridement and drainage of infected necrosis from Sep. 2009 to Dec. 2011 were included. Serum PCT was tested on the day of admission (0 day), one week after admission, one day before surgery, one day after surgery, and one week after surgery. According to the level of serum PCT, all the 93 patients were divided into 3 groups:low level group (PCT < 2 ng/mL), middle level group (PCT 2-10 ng/mL), and high level group (PCT > 0 ng/mL). Postoperative complications were also recorded. ResultsThe incidence of postoperative complications was 19.4% (18/93). There were postoperative bleeding in 13 patients, intestinal fistula in 14 patients, pancreatic fistula in 18 patients, pulmonary infection in 4 patients, residual abscess in 10 patients; re-operation in 15 patients, and death in 8 patients (the death rate was 8.6%). Besides the pulmonary infection, and grade A and C of pancreatic fistula, the incidence of various complications in middle level group and high level group were lower than low level group (P < 0.05). Patients with complications had significantly higher PCT value in one week after admission than onset (P < 0.05). PCT value was higher in the patients with intestinal fistula and residual abscess on one day after operation than on one day before operation (P < 0.05). Patients who died or with re-operation had significantly higher PCT value in one week after operation than on one day after operation (P < 0.05). In the dead patients, the serum PCT sustained at a high level after operation. ConclusionsThe level of serum PCT is correlated with the incidence of postoperative complications. Dynamic monitoring the level of serum PCT can guide the choice of operative time and assessment of postoperative complications including intestinal fistula, pulmonary infection, and death, which can greatly improve the prognosis of SAP.
ObjectiveTo evaluate the postoperative complications after pancreaticoduodenectomy with modified triple-layer(MTL) duct-to-mucosa pancreaticojejunostomy and with resection of jejunal serosa, analyse the risk factors of pancreatic fistula, and compare effects with two-layer(TL) duct-to-mucosa pancreaticojejunostomy. MethodsData on 184 consecutive patients who underwent the two methods of pancreaticojejunostomy during standard PD between January 1, 2010 and January 31, 2013 were collected retrospectively. The risk factors of pancreatic fistula were investigated by using univariate and multivariate analyses. ResultsA total of 88 patients received TL and 96 underwent MTL. Rate of pancreatic fistula for the entire cohort was 8.2%(15/184). There were 11 fistulas(12.5%) in the TL group and four fistulas(4.2%) in the MTL group(P=0.039). Body mass index, pancreatic texture, pancreatic duct diameter, and methods of pancreaticojejunostomy had significant effects on the formation of pancreatic fistula on univariate analysis. Multivariate analysis showed that pancreatic duct diameter less than 3 mm and TL were the significant risk factors of pancreatic fistula. ConclusionsMTL technique effectively reduced the pancreatic fistula rate after PD in comparison with TL, especially in patients with pancreatic duct diameter less than 3 mm.