Percutaneous catheter drainage under positioning of electrode plates and ultrasound guidance: a report of 61 cases
Objective: To describe the experiences in treatment of infected pancreatic necrosis (IPN) by percutaneous catheter drainage (PCD) under positioning of the electrode plates and ultrasound guidance. Methods: The clinical data of 61 patients with IPN undergoing PCD under positioning of the electrode plates and ultrasound guidance between October 2010 and December 2016 were retrospectively analyzed. Results: PCD was successfully performed in the entire group of the 61 patients, of whom, 23 cases (37.7%) underwent PCD alone, 22 cases (36.1%) were converted to minimal access retroperitoneal pancreatic necrosectomy (MARPN) and 16 cases (26.2%) were converted to open pancreatic necrosectomy (OPN) after PCD. The mortality rate in the whole group was 24.6% (15/61), which included 6 cases undergoing PCD alone, 4 cases undergoing MARPN conversion and 5 cases undergoing OPN conversion. After PCD, complications occurred 36 times that included 12 times of bleeding, 15 times of pancreatic leakage and 9 times of intestinal leakage. Results of the drainage fluid cultures showed 19 cases (31.1%) had mono-bacterial infection and 42 cases (68.9%) had mixed bacterial infections, in which 38 cases (62.3%) were caused by multi-drug resistant organisms (MDRO). The factors associated with death of the patients included the severity score of acute pancreatitis (2012), reversal of sepsis after surgical intervention, bleeding after PCD and MDRO infection (all P<0.05). Conclusion: PCD under positioning of the electrode plates and ultrasound guidance is a simple and safe method of peripancreatic fluid drainage, based on which, the “step-up” approach is an effective strategy for dealing with IPN.