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DOI: 10.1055/s-2001-11717
J.A.Barth Verlag in Medizinverlage Heidelberg GmbH & Co.KG
Möglichkeiten und Grenzen der interventionellen Therapie bei nekrotisierender Pankreatitis
Publication History
Publication Date:
31 December 2001 (online)
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Possibilities and borderlines of interventional therapy in necrotizing pancreatitis
Summary
We present a new technique for minimal invasive radiological assisted necrosectomy (MIRAN) for infected necrosis in acute pancreatitis. We describe how to place volumic catheters for fragmentation and extraction of necrotic material. In addition a new technique is described for minimal invasive occlusion of selected pancreas tail to avoid fistulas. In 26 patients with infected necrosis of the pancreatic region, 12 patients (46.2 %) could be healed by MIRAN alone. 5 patients (19.2 %) could be satisfactory treated with a combination of MIRAN and operative necrosectomy. 9 patients (34.6 %) died, 5 of them postoperatively. In 7 cases death followed multiple organ failure/dysfunction syndrome. 12 (71 %) of 17 patients with the aim of curative treatment could be satisfactory treated with MIRAN. 2 other patients (12 %) received additional surgery, 3 patients died (17 %), 2 of them without any other treatment. The advantages of MIRAN are reduced trauma, general anasthesia is not necessary, no difficult surgical preparation is necessary, no limits for additional therapy, reduced damage of neighbouring organs and vital pancreatic tissue as well as avoiding splenectomy.
Zusammenfassung
In dieser Arbeit wird ein neuartiges Verfahren zur minimal-invasiven radiologisch assistierten Nekrosektomie (MIRAN) bei akuter Pankreatitis mit infizierten Nekrosen vorgestellt. Es wird die Technik der Einlage großlumiger Katheter beschrieben, über die Sequester und größere Nekroseareale fragmentiert und ausgespült werden können. Zusätzlich wird eine neuartige Technik der Okklusion abgehängter Pankreasschwanzareale zu Vermeidung von Fisteln vorgestellt. Bei insgesamt 26 Patienten konnten zwölf (46,2 %) allein mit Drainage geheilt werden, fünf (19,2 %) wurden mit der Kombination Drainage/Operation geheilt und neun Patienten starben, davon waren fünf Patienten operiert worden. Sieben Todesfälle (26,9 %) waren auf die akute nekrotisierende Pankreatitis und das nachfolgende MODS zurückzuführen.
Von 17 Patienten mit kurativer Zielsetzung wurden 12 nur mit Hilfe der radiologischen Intervention geheilt (71 %), 2 zusätzlich operiert (12 %) und 3 verstarben (17 %), davon zwei ohne weitere Maßnahmen. Die Vorteile der MIRAN bei akuter nekrotisierender Pankreatitis sind ein im Vergleich zur Operation deutlich geringeres Trauma [3]. Ferner ist eine Narkose oft nicht nötig, dies ist insbesondere ein Vorteil bei multimorbiden Patienten mit kardiopulmonalen Risiken. Schwierige Zugangswege, die komplikationsreiche Präparationen bei operativem Vorgehen nötig machen, entfallen. MIRAN führt nicht zum Ausschluß einer nachfolgenden Therapie, etwa eines operativen Eingriffes, da eine Verklebung intraabdomineller Organe vermieden wird. Entgegen dem konventionellen operativen Vorgehen bietet die MIRAN meist Schutz vor Verletzung oder Resektion vitalen Pankreasgewebes und in einzelnen Fällen kann eine Splenektomie vermieden werden.
Key words
Acute pancreatitis - infected necrosis - minimal invasive procedure
Schlüsselwörter
Akute Pankreatitis - infizierte Nekrose - minimal-invasives Vorgehen
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Dr. Stefan Mann
Chirurgische Klinik und Poliklinik
Universität Regensburg
Franz-Josef-Strauß-Allee 11
D-93042 Regensburg