摘要
【目的】探析CT引导穿刺引流联合经皮肾镜微创治疗急性重症胰腺炎（ASP）合并胰周组织坏死的效果。【方法】取2011年2月至2013年11月本院收治的20例确诊为ASP合并胰周组织坏死患者，其中4例为高脂血症所致胰腺炎，胆源性胰腺炎16例，为初治患者。所有患者入院因脾脏、胃肠道、胆道等遮挡，无适当的穿刺路径，超声穿刺置管引流改行CT引导下穿刺引流联合经皮肾镜治疗。【结果】①患者CT引导下穿刺抽液细菌学检查为肠球菌、大肠杆菌、假单胞菌属、变形杆菌、霉菌单一细菌感染或两种以上细菌混合感染。②C T引导经皮穿刺引流成功率100％，16例经皮肾镜清除胰腺坏死感染组织1次后，炎症感染症状迅速控制，1例术中解剖结构粘连，转开腹手术，2例因术中坏死组织清除不彻底行二次手术，1例高脂血症性胰腺炎外院转入，术后并发多功能脏器衰竭。③15例患者术后5～9 d好转后经治愈出院，4例术后14～17 d住院带管出院，1例并发多脏器功能衰竭治疗4周后病情好转。无死亡病例，所有患者平均住院时间（13．5±1．6）d。【结论】对ASP合并胰周组织坏死者，在临床生命体征控制稳定后，结合临床传统的内外科治疗手段，采取CT引导下引流经皮肾镜微创技术，可最大程度降低手术对机体的创伤，清除坏死感染组织，促进病情好转，取得较好的疗效。
[Objective] To explore the efficacies of computed tomography （CT ）‐guided puncture drainage plus percutaneous nephroscope for peripancreatic abscess （PA ） due to acute severe pancreatitis （ASP ） .[Methods] A total of 20 patients with PA due to ASP were recruited from our emergency department from February 2011 to November 2013 .The etiologies were idiopathic （ n=4） and gallstone （ n=16） .All patients were admitted because of shades of spleen ,gastrointestinal tract or billiary tract .No proper puncture path was available .Ultrasonic drainage tube was switched to CT‐guided puncture drainage with percutaneous nephro‐scope .[Results] （1） Bacteriological examination of CT‐guided puncture liquid revealed a single or dual infec‐tion of enterococcus ,Escherichia coli ,pseudomonas ,proteus and fungus ;（2） CT‐guided percutaneous punc‐ture yielded a drainage rate of 100% .After one‐time removal of pancreatic necrosis ,the infections were quick‐ly controlled in 16 cases .One case of intraoperative adhesion of anatomical structures was converted to undergo open operation .Two cases with residual necrotic tissues were re‐operated .And one case of hyperlipidemia was transferred from another hospital and had a postoperative onset of multifunctional organ failure ;（3） Fifteen curative cases were discharged at Days 5～9 .And 4 cases left with a tube at Days 14～17 .One case complicat‐ed with multiple organ failure improved after 4‐week treatment .There was no mortality .And the average length of hospital stay was （13 .5 ± 1 .6） days .[Conclusion] After a stabilization of vital signs ,puncture drainage under CT‐guided percutaneous nephroscope may minimize tissue trauma ,remove necrotic tissues and obtain optimal outcomes .
出处
《医学临床研究》
CAS
2015年第4期675-677,共3页
Journal of Clinical Research
