Clinical analysis of fungal infected pancreatic necrosis: a report of 46 cases
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胰腺炎;胰腺炎,急性坏死性;感染;真菌

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    Abstract:

    Objective: To analyze the morbidity situation of fungal infected pancreatic necrosis (IPN) as well as its surgical treatment and clinical outcomes. Methods: The clinical data of 145 consecutive patients with IPN treated in Xiangya Hospital of Central South University from January 2010 to July 2018 were retrospectively analyzed, with a particular focus on those associated with fungal IPN. Results: Of the 145 IPN patients, a total of 46 cases were fungal IPN (31.7%); the results of time distribution analysis showed that fungal IPN had the highest proportion in the last two years (2017 to 2018), which reached 40.7%; all the 46 patients were monilial infections, which were caused mainly by monilia albicans (25 cases), secondly by candida albicans (14 cases) and thirdly by candida tropicalis (7 cases). Of the 46 patients, 41 cases underwent step-up treatment approach and 5 cases received step-down treatment approach. In fungal IPN patients, the number of total surgical interventions was 159 times, and the average number of surgical interventions was significantly higher than that in non-fungal IPN patients (3.5 times per case vs. 2.7 times per case, P<0.05). The mortality rate in the entire group of patients was 22.1% (32/145), which in fungal IPN patients was 17.3% (8/46) and in non-fungal IPN patients was 24.2% (24/99), and the difference had no significance (P>0.05). Of the 46 patients, 4 cases had concomitant bloodstream fungal infection, in whom, the mortality rate was significantly higher than that in those without bloodstream fungal infection [75% (3/4) vs. 14.3% (5/42), P<0.05]. Conclusion: The incidence of fungal IPN exhibits a rising trend. Although fungal infection does not increase the mortality in IPN patients, it always requires more surgical interventions, and the mortality is significantly increased when combined with bloodstream fungal infection. Thus, proper selection of antifungal agents and thorough control of the source of infection are the essential prerequisites for successful treatment of fungal IPN.

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NING Caihong, HUANG Gengwen, SHEN Dingcheng, LIN Jiayan, CAO Xintong, JI Liandong. Clinical analysis of fungal infected pancreatic necrosis: a report of 46 cases[J]. Chin J Gen Surg,2018,27(9):1155-1159.
DOI:10.7659/j. issn.1005-6947.2018.09.011

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History
  • Received:August 05,2018
  • Revised:August 29,2018
  • Adopted:
  • Online: September 15,2018
  • Published: