Prognosis of patients with infected pancreatic necrosis undergoing laparoscopic retroperitoneal pancreatic necrosectomy

doi:10.3877/cma.j.issn.2096-1537.2026.02.008

Abstract

Abstract:

Objective

To evaluate the impact of laparoscopic retroperitoneal pancreatic necrosectomy (LPRN) on 90-day mortality and 30-day postoperative bleeding in IPN patients.

Methods

A single-center retrospective cohort study included 87 IPN patients who were admitted to Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from January 2013 to December 2020. Patients were divided into the LPRN group (n=65) and the open surgery group (n=22). Kaplan-Meier survival analysis, multivariate Cox regression, and Logistic regression were used to assess the impact of LPRN on patient outcomes.

Results

The 90-day mortality rate was significantly lower in the LPRN group compared to the open surgery group (12.31% vs 45.45%, P＜0.001), and the incidence of postoperative bleeding within 30 days was also significantly reduced (15.38% vs 40.91%, P=0.012). Multivariate regression analysis showed that LPRN significantly reduced the 90-day mortality risk (HR=0.13, 95% CI: 0.02-0.55) and the risk of 30-day postoperative bleeding (OR=0.24, 95% CI: 0.07-0.74). E-value analysis indicated the robustness of these results to potential unmeasured confounding. Subgroup analysis further confirmed that the trend towards improved outcomes associated with LPRN remained consistent across stratifications based on etiology, hematocrit, sequential organ failure assessment (SOFA) score, American Society of Anesthesiologists (ASA) classification, and the presence of preoperative septic shock.

Conclusion

LPRN may be associated with improved short-term outcomes in patients with infected pancreatic necrosis (IPN), though this requires further validation through prospective studies. Clinical decision-making should be based on individual patient factors, and the long-term efficacy as well as the applicable scope of LPRN need to be further investigated.

Key words: Laparoscopic retroperitoneal pancreatic necrosectomy, Severe acute pancreatitis, Infected pancreatic necrosis

Zhendong Fang, Weipeng Huang, Yifan Gao, Hong Yu, Bo Shen, Feng Guo. Prognosis of patients with infected pancreatic necrosis undergoing laparoscopic retroperitoneal pancreatic necrosectomy[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2026, 12(02): 141-146.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2026.02.008

https://icu.cma-cmc.com.cn/EN/Y2026/V12/I02/141

Figures/Tables 4

基线特征	开腹组（22例）	LPRN组（65例）	统计值	P值
年龄（岁， $x ¯$ ±s）	42.91±13.85	44.98±14.65	t=0.58	0.562
性别[例（%）]			χ²=0.07	0.785
女	5（22.73）	13（20.00）
男	17（77.27）	52（80.00）
体质量指数（kg/m²， $x ¯$ ±s）	26.40±5.05	25.97±4.82	t=0.36	0.720
血细胞比容（%， $x ¯$ ±s）	34.55±10.73	32.58±10.08	t=0.76	0.448
白细胞[×10⁹/L，M（Q_R）]	14.85（2.10~67.10）	11.50（2.50~37.00）	Z=1.35	0.179
血钙（mmol/L， $x ¯$ ±s）	2.02±0.35	2.06±0.31	t=0.51	0.610
白蛋白（g/L， $x ¯$ ±s）	32.48±5.59	31.53±6.84	t=0.59	0.557
总胆红素[μmol/L，M（Q_R）]	23.85（6.90~329.90）	23.90（6.60~255.60）	Z=0.02	0.984
SOFA评分[分，M（Q_R）]	7.00（0.00~16.00）	4.00（0.00~19.00）	Z=2.01	0.044
Marshall评分[分，M（Q_R）]	5.00（0.00~9.00）	3.00（0.00~24.00）	Z=1.45	0.147
ASA分级评分（分， $x ¯$ ±s）	3.45±0.74	3.00±0.59	t=2.94	0.004
发病至手术时间窗（d， $x ¯$ ±s）	35.59±20.57	44.26±19.75	t=1.76	0.082
PCD至手术时间窗（d， $x ¯$ ±s）	14.73±18.93	18.74±14.79	t=1.02	0.310
病因[例（%）]			χ²=2.67	0.263
高脂性	11（50.00）	21（32.31）
胆源性	6（27.27）	31（47.69）
其他	5（22.73）	13（20.00）
术前穿刺（PCD）[例（%）]			-	＞0.999
未穿刺	0（0.00）	0（0.00）
穿刺	22（100.00）	65（100.00）
术前感染性休克[例（%）]			χ²=0.31	0.581
有	14（63.64）	37（56.92）
无	8（36.36）	28（43.08）
90 d死亡[例（%）]			χ²=10.45	＜0.001
存活	12（54.55）	57（87.69）
死亡	10（45.45）	8（12.31）
术后30 d出血[例（%）]			χ²=6.29	0.012
无	13（59.09）	55（84.62）
有	9（40.91）	10（15.38）

基线特征	开腹组（22例）	LPRN组（65例）	统计值	P值
年龄（岁， $x ¯$ ±s）	42.91±13.85	44.98±14.65	t=0.58	0.562
性别[例（%）]			χ²=0.07	0.785
女	5（22.73）	13（20.00）
男	17（77.27）	52（80.00）
体质量指数（kg/m²， $x ¯$ ±s）	26.40±5.05	25.97±4.82	t=0.36	0.720
血细胞比容（%， $x ¯$ ±s）	34.55±10.73	32.58±10.08	t=0.76	0.448
白细胞[×10⁹/L，M（Q_R）]	14.85（2.10~67.10）	11.50（2.50~37.00）	Z=1.35	0.179
血钙（mmol/L， $x ¯$ ±s）	2.02±0.35	2.06±0.31	t=0.51	0.610
白蛋白（g/L， $x ¯$ ±s）	32.48±5.59	31.53±6.84	t=0.59	0.557
总胆红素[μmol/L，M（Q_R）]	23.85（6.90~329.90）	23.90（6.60~255.60）	Z=0.02	0.984
SOFA评分[分，M（Q_R）]	7.00（0.00~16.00）	4.00（0.00~19.00）	Z=2.01	0.044
Marshall评分[分，M（Q_R）]	5.00（0.00~9.00）	3.00（0.00~24.00）	Z=1.45	0.147
ASA分级评分（分， $x ¯$ ±s）	3.45±0.74	3.00±0.59	t=2.94	0.004
发病至手术时间窗（d， $x ¯$ ±s）	35.59±20.57	44.26±19.75	t=1.76	0.082
PCD至手术时间窗（d， $x ¯$ ±s）	14.73±18.93	18.74±14.79	t=1.02	0.310
病因[例（%）]			χ²=2.67	0.263
高脂性	11（50.00）	21（32.31）
胆源性	6（27.27）	31（47.69）
其他	5（22.73）	13（20.00）
术前穿刺（PCD）[例（%）]			-	＞0.999
未穿刺	0（0.00）	0（0.00）
穿刺	22（100.00）	65（100.00）
术前感染性休克[例（%）]			χ²=0.31	0.581
有	14（63.64）	37（56.92）
无	8（36.36）	28（43.08）
90 d死亡[例（%）]			χ²=10.45	＜0.001
存活	12（54.55）	57（87.69）
死亡	10（45.45）	8（12.31）
术后30 d出血[例（%）]			χ²=6.29	0.012
无	13（59.09）	55（84.62）
有	9（40.91）	10（15.38）

模型	90 d病死率		术后30 d出血
模型	HR值（95%CI）	P值	OR值（95%CI）	P值
未调整	0.17（0.05~0.51）	＜0.01	0.26（0.09~0.78）	0.016
调整Ⅰ	0.12（0.03~0.41）	＜0.01	0.24（0.07~0.74）	0.014
调整Ⅱ	0.13（0.02~0.55）	＜0.01	0.24（0.07~0.74）	0.014

亚组变量	90 d病死率			术后30 d出血
亚组变量	HR（95%CI）	P值	交互P值	OR（95%CI）	P值	交互P值
病因			0.2969			0.4346
高脂	0.22（0.04~1.23）	0.0857		0.11（0.02~0.75）	0.0242
胆源性	0.11（0.02~0.55）	0.0078		0.22（0.04~1.30）	0.0954
其他	0.35（0.07~1.66）	0.1858		0.55（0.09~3.23）	0.5072
感染性休克			0.0930			0.7362
有	0.44（0.06~3.44）	0.4368		0.26（0.04~1.65）	0.1535
无	0.70（0.10~4.91）	0.7207		0.65（0.11~ 4.04）	0.6474
血细胞比容			0.1490			0.6473
＜44%	0.09（0.02~0.54）	＜0.0100		0.21（0.05~0.96）	0.0435
≥44%	0.16（0.01~1.68）	0.1255		0.38（0.04~ 3.72）	0.4091
血钙			0. 8982			0.7286
＜2 mmol/L	0.17（0.02~1.56）	0.1176		0.21（0.02~2.68）	0.2266
≥2 mmol/L	0.09（0.01~0.85）	0.0352		0.60（0.06~ 6.00）	0.6601
SOFA评分			0.8515			0.3097
＜3分	0.15（0.01~2.85）	0.2044		0.07（0.00~ 1.38）	0.0797
≥3分	0.19（0.02~2.08）	0.1734		0.07（0.01~ 0.74）	0.0273
ASA分级评分			0.3688			0.1955
≤3分	0.04（0.00~2.47）	0.1249		0.23（0.01~0.98）	0.0420
＞3分	0.15（0.01~2.66）	0.1955		0.13（0.01~2.42）	0.2807

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