[Ultrasound-guided percutaneous tube drainage combined with directly-viewed debridement with cholangioscopy: a mini-invasive strategy for peripancreatic necrotizing infection].
OBJECTIVE
To establish "an integrative therapy" of drainage and debridement on peripancreatic necrotizing infection (PPNI) with minimally invasive technique, and to detect its clinical effects.


METHODS
There were 17 patients who accepted ultrasound-guided percutaneous tube drainage combined with directly-viewed debridement with cholangioscopy from March 2006 to January 2008. Percutaneous puncture and catheter (6 - 8 F) drainage were adopted on the patients suffering from PPNI with B-us guidance, then the drainage sinus was expanded progressively from 8 F to 24 F in diameter with Cook fascia dilator by degrees, and the 22 F or 24 F tube was easily placed into the interior of PPNI instead of the prior catheter. So a better drainage effect was achieved. One week later, the necrotizing tissue of PPNI could be observed and debrided with choledochoscope under a directly-viewed way through the enlarged new sinus. Thus, with the continuous tube drainage and repeated debridement, the focus was absorbed and covered gradually.


RESULTS
Seventeen cases accepted the mini-invasive therapy, 15 cases were saved finally with cure rate of 88.2%, and 2 cases conversion to laparotomy because of some technical reasons. The mean healing time was 73 days, and the mean hospitalization time was 57 days. Bleeding was occurred in 2 cases localized in sinus and the inside of PPNI, digestive tract fistula was detected in 2 cases, and these patients with the complications were cured under nonoperative management. All the patients were still alive with following-up, neither remains nor recurrence of the PPNI was found in our group.


CONCLUSIONS
Ultrasound-guided percutaneous tube drainage combined with directly-viewed debridement with cholangioscopy, as a mini-invasive therapy, could complete the goal-directed therapy of PPNI, meanwhile, realize the modern surgery ideal of damage control.
Wang
Tao
T
Department of General Surgery, General Hospital of the Chengdu Army, Chengdu 610083, China. watopo@163.com
Tang
Li-jun
LJ
Tian
Fu-zhou
FZ
Chen
Tao
T
Tang
Ming-jun
MJ
Liu
Wen-qing
WQ
Ma
Li-hong
LH
D000328:Adult; D000368:Aged; D003646:Debridement / Q000379:methods*; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009336:Necrosis / Q000209:etiology / Q000601:surgery; D010182:Pancreatic Diseases / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000601:surgery