摘要
目的:探讨超声引导下经皮置管引流(PCD)治疗重症急性胰腺炎(SAP)合并感染性坏死相关影响因素以及联合胆道镜清创的疗效。方法:回顾性分析2011年1月—2012年12月以超声引PCD为初始治疗手段的65例SAP合并感染性坏死患者临床资料。结果:38例(58.5%)仅通过PCD引流治愈,27例(41.5%)需要进一步处理的患者中,4例(6.2%)直接转为开腹手术;23例(35.4%)采取胆道镜引导的腹膜后清创,其中2例因相关并发症转为开腹手术。6例(9.2%)经过PCD或者后续微创/开腹手术治疗后死亡。将单独行PCD治愈的患者与行PCD及后续治疗的患者的资料比较,结果显示,两者的人口学资料、严重度评分、白细胞计数、C反应蛋白及凝血酶原消耗试验等指标差异均无统计学意义(均P>0.05),首次PCD治疗时间、穿刺引流管管径上差异也均无统计学意义(均P>0.05),但前者引流管数量多于后者、引流时间长于后者、穿刺相关并发症低于后者,差异具有统计学意义(均P<0.05)。结论:引流管数量、引流时间、穿刺相关并发症是PCD的影响因素,对于合并感染性坏死的SAP,联合胆道镜清创是安全有效的微创治疗方法。
Objective： To determine the affecting factors for ultrasound-guided percutaneous catheter drainage （PCD） in treatment of severe acute pancreatitis （SAP） with infected necrosis and the efficacy of its combination with choledochoscopic necrosectomy .Methods： The clinical data of 65 SAP patients complicated with infected pancreatic necrosis undergoing ultrasound-guided PCD as initial treatment during January 2011 to December 2012 were retrospectively analyzed.Results： Thirty-eight patients （58.5%） were cured by PCD only, and in the 27 patients （41.5%） requiring further treatment after PCD, 4 cases were directly converted to open operation, and 23 cases （35.4%） underwent retroperitoneal choledochoscopic necrosectomy, of which 2 cases required an open conversion due to the procedure-related complications. Six patients （9.2%） died after PCD or PCD plus subsequent minimally invasive or open surgical treatment. Results from the comparison of the data between patients who were cured by PCD alone and those requiring further treatment showed that there were no statistically significant differences in the demographic data, severity scores, or other indexes such as white blood cell count, C-reactive protein level and prothrombin consumption test （all P〉0.05）, and no statistical difference as well in time of the first PCD or the diameter of the catheter drainage tube between them （all P〉0.05）, but the number of drainage tube placement was greater, drainage time was longer and incidence of complications was lower in the former than those in the latter, with statistical difference （all P〈0.05）. Conclusion： Number of drainage tube factors for PCD, and PCD combined placement, drainage time and p with choledochoscopic debri invasive treatment for SAP with infected necrosis. uncture-related complications are affecting dement is a safe and effective minimally invasive treatment for SAP with infected necrosis.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2014年第9期1171-1175,共5页
China Journal of General Surgery
关键词
胰腺炎
急性坏死性
坏死
感染性
外科手术
微创性
Pancreatitis, Acute Necrotizing
Necrosis, Infected
Surgical Procedures, Minimally Invasive
