Objective: To assess the clinical efficacy of necrotic pancreatic tissue removal through a small incision along the existing tract of the PCD tube combined with percutaneous nephroscope in treatment of severe acute pancreatitis (SAP) complicated with infected necrosis. Methods: In 23 SAP patients at infection stage after receiving poor treatment such as inadequate drainage, a small incision approximately 2 cm in length along the tract of the PCD tube was made, through which, the necrotic pancreatic tissue in the superficial areas was removed with a lithotomy forceps, and in the deep areas was cleared visually by baskets via the combined percutaneous nephroscope. A douche tube and a double cannula were respectively inserted in the superior area and the inferior area of the residual space after necrotic pancreatic tissue removal, and the tubes were then brought out through abdominal wall at relatively thin sites and secured in places. The previous incision wound of PCD tube was closed. After above operation, the residual necrotic tissue was gradually cleared by irrigation of the purulent cavity with normal saline through the douche tube, and continuous drainage of the double cannula under a negative pressure. The drainage volume (difference between input and output), body temperature, white blood cell (WBC) counts, procalcitonin (PCT) and C-reactive protein (CRP) before and after treatment were monitored and recorded. Review abdominal CT examination was performed on one month after surgery to check the residual necrotic tissue around the pancreas. Results: In the 23 SAP patients at infection stage and underwent the above treatment, the symptoms of infection or intoxication were all improved, the drainage volumes were significantly increased within postoperative day 30 compared with preoperative level (all P<0.05), and the infection indexes (body temperature, WBC count, PCT and CRP) were significantly decreased at different time points after operation compared with their preoperative levels (all P<0.05). About one month after the operation, the result of review CT examination showed peripancreatic necrosis tissue and collections had largely disappeared. Douche tube change was required in 5 patients due to drainage tube blockage at 2 weeks postoperatively. No complications such as abdominal hemorrhage, intestinal leakage or perforation occurred, and no minimally invasive surgical intervention or open surgery was required in any of them. Finally, all patients recovered and were discharged. Conclusion: Necrotic pancreatic tissue removal through a small incision along the tract of PCD tube combined with percutaneous nephroscope has demonstrable clinical efficacy in treatment of SAP complicated with infected necrosis.