RESUMEN
Reports have focused on the perceived benefit of a new method of managing pancreatic necrosis and sepsis: leaving the abdomen packed open after debridement, the "marsupialization" technique. We have continued to treat infected pancreatic necrosis with aggressive pancreatic debridement and drainage, closure of the abdomen, and prompt reoperation as often as necessary if further sepsis is identified. We report 52 consecutive patients with infected pancreatic necrosis operated upon between July, 1972 and March, 1990. Postoperative organ failure and APACHE II scoring correlated with survival. Patients with APACHE II scores less than 15 had an operative mortality rate of 4 per cent, whereas patients with scores greater than 15 had a 44 per cent mortality rate. We recognize that no two retrospective series are truly comparable, but in comparison to published reports on the open technique, fascial closure after pancreatic debridement appeared to produce fewer wound complications (only one dehiscence and one incisional hernia) and fewer trips to the operating room.
Asunto(s)
Abdomen/cirugía , Infecciones Bacterianas/cirugía , Fasciotomía , Pancreatitis/microbiología , Pancreatitis/cirugía , Bacteriemia/microbiología , Gasto Cardíaco Bajo/complicaciones , Causas de Muerte , Desbridamiento , Drenaje , Femenino , Hemorragia Gastrointestinal/complicaciones , Humanos , Fallo Hepático/complicaciones , Masculino , Necrosis , Pancreatitis/complicaciones , Pancreatitis/patología , Insuficiencia Renal/complicaciones , Insuficiencia Respiratoria/complicaciones , Índice de Severidad de la Enfermedad , Tasa de SupervivenciaRESUMEN
Twenty-seven women with disseminated estrogen receptor-negative breast cancer received an aggressive chemotherapy program of prednisone, methotrexate, 5-FU, doxorubicin, and cyclophosphamide. Responses were achieved in 21 of 26 (81%) evaluable patients, eight (31%) of whom had complete responses. The median survival was 17 months. Despite the favorable overall response and a significant number of complete responses, all patients eventually relapsed. Although most patients relapsed systematically, two relapsed initially in the CNS.