临床研究(Clinical Research)

电极片定位超声引导下经皮穿刺置管引流治疗感染性胰腺坏死:附61例报告

Published at: 2017年第26卷第9期

申鼎成 1 , 刘志勇 2 , 黄耿文 1 , 周书毅 1
1 中南大学湘雅医院胰胆外科,湖南 长沙 410008
2 中南大学湘雅医院重症医学科,湖南 长沙 410008
通讯作者 耿文 黄 Email: 1466471168@qq.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.09.014
基金:
中南大学湘雅医院管理研究基金资助项目 2016GL12

摘要

目的:总结电极片定位超声引导下经皮穿刺置管引流(PCD)治疗感染性胰腺坏死(IPN)的经验。方法:回顾性分析2010年10月—2016年12月间61例采用电极片定位超声引导下PCD治疗的IPN的临床资料。结果:全组61例均顺利施行PCD。23例(37.7%)仅行PCD治疗,22例(36.1%)经PCD治疗后中转微创腹膜后入路胰腺坏死组织清除术(MARPN),16例(26.2%)患者经PCD治疗后中转开腹胰腺坏死组织清除术(OPN)。全组病死率24.6%(15/61),包括仅行PCD治疗6例、中转MARPN者4例和中转OPN者5例。PCD术后并发症36例次,包括12例次出血,15例次胰瘘,9例次肠瘘。穿刺引流液培养结果包括单菌种感染19例(31.1%)和多重感染42例(68.9%),其中多重耐药菌(MDRO)感染38例(62.3%)。与患者死亡有关的因素包括2012版急性胰腺炎严重程度分级、外科干预后脓毒症是否逆转、穿刺并发出血以及MDRO感染(均P<0.05)。结论:电极片定位超声引导下PCD是一种相对简便安全的胰周穿刺引流方法,以此为基础的“升阶梯”治疗策略是治疗IPN的有效策略。


Percutaneous catheter drainage under positioning of electrode plates and ultrasound guidance: a report of 61 cases

Abstract

Objective: To describe the experiences in treatment of infected pancreatic necrosis (IPN) by percutaneous catheter drainage (PCD) under positioning of the electrode plates and ultrasound guidance. Methods: The clinical data of 61 patients with IPN undergoing PCD under positioning of the electrode plates and ultrasound guidance between October 2010 and December 2016 were retrospectively analyzed. Results: PCD was successfully performed in the entire group of the 61 patients, of whom, 23 cases (37.7%) underwent PCD alone, 22 cases (36.1%) were converted to minimal access retroperitoneal pancreatic necrosectomy (MARPN) and 16 cases (26.2%) were converted to open pancreatic necrosectomy (OPN) after PCD. The mortality rate in the whole group was 24.6% (15/61), which included 6 cases undergoing PCD alone, 4 cases undergoing MARPN conversion and 5 cases undergoing OPN conversion. After PCD, complications occurred 36 times that included 12 times of bleeding, 15 times of pancreatic leakage and 9 times of intestinal leakage. Results of the drainage fluid cultures showed 19 cases (31.1%) had mono-bacterial infection and 42 cases (68.9%) had mixed bacterial infections, in which 38 cases (62.3%) were caused by multi-drug resistant organisms (MDRO). The factors associated with death of the patients included the severity score of acute pancreatitis (2012), reversal of sepsis after surgical intervention, bleeding after PCD and MDRO infection (all P<0.05). Conclusion: PCD under positioning of the electrode plates and ultrasound guidance is a simple and safe method of peripancreatic fluid drainage, based on which, the “step-up” approach is an effective strategy for dealing with IPN.


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引用

引用本文: 鼎成 申, 志勇 刘, 耿文 黄, 书毅 周. 电极片定位超声引导下经皮穿刺置管引流治疗感染性胰腺坏死:附61例报告[J]. 中国普通外科杂志, 2017, 26(9): 1168-1173.
Cite this article as: SHEN Dingcheng, LIU Zhiyong, HUANG Gengwen, ZHOU Shuyi . Percutaneous catheter drainage under positioning of electrode plates and ultrasound guidance: a report of 61 cases [J]. Chin J Gen Surg, 2017, 26(9): 1168-1173.