专题研究(Monographic Study)

经腹膜后入路胰腺坏死组织清除引流术治疗胰腺坏死感染

Published at: 2016年第25卷第3期

邱进 1 , 高鹏 1
1 河南省濮阳市油田总医院 普通外科,河南 濮阳 457001
通讯作者 进 邱 Email: qiujin1212@139.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2016.03.004
基金:

摘要

目的:探讨胰腺坏死并感染采用经腹膜后入路胰腺坏死组织清除引流术治疗的临床效果与安全性。方法:选择2013—2015 年采取经腹膜后入路胰腺坏死组织清除引流术治疗的44 例胰腺坏死并感染患者为观察组、既往采用经腹部切口入路清除坏死组织后持续闭合冲洗治疗56 例胰腺坏死并感染患者为对照组,对比两组患者的手术效果。结果:两组术前一般资料及各项实验室指标差异均无统计学意义(均P>0.05)。治疗后,观察组的血淀粉酶、尿淀粉酶、血糖、降钙素原、肿瘤坏死因子α、白细胞介素8 值均明显低于对照组患者(均P<0.05);观察组患者的手术时间、住院时间均明显短于对照组(均P<0.05),两组患者的再次手术率、死亡或放弃治疗率无统计学差异(均P>0.05);观察组有效率高于对照组(75.0% vs. 58.9%)、手术并发症发生率低于对照组(15.9% vs. 33.9%),但均无统计学差异(均P>0.05)。结论:胰腺坏死并感染采用经腹膜后入路胰腺坏死组织清除引流术效果可靠,且较开腹手术恢复快、创伤小。


Debridement of necrotic pancreatic tissue and drainage via retroperitoneal approach for infected pancreatic necrosis

Abstract

Objective: To investigate the clinical efficacy and safety of debridement of necrotic pancreatic tissue and drainage via retroperitoneal approach in management of infected pancreatic necrosis. Methods: Forty-four patients with infected pancreatic necrosis undergoing necrosectomy and drainage via retroperitoneal approach during 2013 to 2015 were enrolled as observational group, and previous 56 patients with the same condition undergoing necrosectomy via abdominal incision and then closed continuous irrigation served as control group. The treatment results between the two groups of patients were compared. Results: The general data and all laboratory indexes before operation between the two groups had no statistical difference (all P>0.05). The levels of serum amylase, urine amylase, blood sugar, procalcitonin, TNF-α and IL-8 in observational group were all significantly lower than those in control group after operation (all P<0.05). The operative time and length of hospital stay in observational group were significantly reduced compared with control group (both P<0.05). The rate of reoperation and death or treatment abandonment had no statistical difference between the two groups (both P>0.05). In observational group compared with control group, the effective rate was increased (75.0% vs. 58.9%) and incidence of surgical complications was decreased (15.9% vs. 33.9%), but both differences did not reach statistical significance (both P>0.05). Conclusion: Necrosectomy and drainage via retroperitoneal approach for infected pancreatic necrosis has reliable efficacy, and with faster recovery and less invasiveness than open surgery.


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引用

引用本文: 进 邱, 鹏 高. 经腹膜后入路胰腺坏死组织清除引流术治疗胰腺坏死感染[J]. 中国普通外科杂志, 2016, 25(3): 327-332.
Cite this article as: QIU Jin, GAO Peng . Debridement of necrotic pancreatic tissue and drainage via retroperitoneal approach for infected pancreatic necrosis[J]. Chin J Gen Surg, 2016, 25(3): 327-332.