循PCD引流管路径微小切口联合经皮肾镜治疗 重症急性胰腺炎感染性坏死
| 作者: |
1刘国华,
1戴东,
1谭小宇
1 广东医科大学附属医院 肝胆外科，广东 湛江 524000 |
| 通讯: |
刘国华
Email: lgheagle@126.com |
| DOI: | 10.3978/. |
摘要
目的：探讨循PCD引流管路径作微小切口联合经皮肾镜清除胰腺坏死组织的方法治疗重症急性胰腺炎（SAP）感染性坏死的临床效果。
方法：23例经PCD引流的感染期SAP患者出现引流不畅等治疗效果不佳后，循PCD引流管路径作一约2 cm微小切口，用取石钳取出浅层部分胰腺坏死组织，深在部分坏死组织联合经皮肾镜直视下用网篮取出，在残腔的高、低位分别置入冲洗管及双套管，从腹壁相应较簿的位置戳孔引出并固定，原PCD引流管管口予以关闭。术后用生理盐水自冲洗管冲洗脓腔，双套管负压状态下作持续负压吸引将残余坏死组织逐步清除干净。监测记录患者术前、术后引流量（出入量差）、体温、白细胞（WBC）数、降钙素原（PCT）、C-反应蛋白（CRP），术后1个月复查腹部CT了解胰腺周围坏死组织残余情况。
结果：23例感染期SAP经上述方法处理后，感染中毒症状均改善，术后30 d内引流量均较术前明显增多（均P<0.05），感染指标（体温、WBC数、PCT、CRP）均在术后不同时间点较术前明显下降（均P<0.05），术后1个月左右复查CT显示胰周坏死组及积液基本消失，其中5例术后2周出现冲洗管堵塞需换管继续冲洗引流，所有患者未出现腹腔出血、肠漏、穿孔等并发症，无需行二次微创手术干预或开腹手术处理，患者最终均痊愈出院。
结论：循PCD引流管路径作微小切口联合经皮肾镜清除胰腺坏死组织的方法在治疗SAP感染性坏死有较好的临床效果。
关键词：
胰腺炎，急性坏死性；清创术；引流术；最小侵入性外科手术
方法：23例经PCD引流的感染期SAP患者出现引流不畅等治疗效果不佳后，循PCD引流管路径作一约2 cm微小切口，用取石钳取出浅层部分胰腺坏死组织，深在部分坏死组织联合经皮肾镜直视下用网篮取出，在残腔的高、低位分别置入冲洗管及双套管，从腹壁相应较簿的位置戳孔引出并固定，原PCD引流管管口予以关闭。术后用生理盐水自冲洗管冲洗脓腔，双套管负压状态下作持续负压吸引将残余坏死组织逐步清除干净。监测记录患者术前、术后引流量（出入量差）、体温、白细胞（WBC）数、降钙素原（PCT）、C-反应蛋白（CRP），术后1个月复查腹部CT了解胰腺周围坏死组织残余情况。
结果：23例感染期SAP经上述方法处理后，感染中毒症状均改善，术后30 d内引流量均较术前明显增多（均P<0.05），感染指标（体温、WBC数、PCT、CRP）均在术后不同时间点较术前明显下降（均P<0.05），术后1个月左右复查CT显示胰周坏死组及积液基本消失，其中5例术后2周出现冲洗管堵塞需换管继续冲洗引流，所有患者未出现腹腔出血、肠漏、穿孔等并发症，无需行二次微创手术干预或开腹手术处理，患者最终均痊愈出院。
结论：循PCD引流管路径作微小切口联合经皮肾镜清除胰腺坏死组织的方法在治疗SAP感染性坏死有较好的临床效果。
Small incision along the PCD tube tract combined with percutaneous nephroscope in treatment of severe acute pancreatitis complicated with infected necrosis
CorrespondingAuthor:LIU Guohua Email: lgheagle@126.com
Abstract
Objective: To assess the clinical efficacy of necrotic pancreatic tissue removal through a small incision along the existing tract of the PCD tube combined with percutaneous nephroscope in treatment of severe acute pancreatitis (SAP) complicated with infected necrosis.
Methods: In 23 SAP patients at infection stage after receiving poor treatment such as inadequate drainage, a small incision approximately 2 cm in length along the tract of the PCD tube was made, through which, the necrotic pancreatic tissue in the superficial areas was removed with a lithotomy forceps, and in the deep areas was cleared visually by baskets via the combined percutaneous nephroscope. A douche tube and a double cannula were respectively inserted in the superior area and the inferior area of the residual space after necrotic pancreatic tissue removal, and the tubes were then brought out through abdominal wall at relatively thin sites and secured in places. The previous incision wound of PCD tube was closed. After above operation, the residual necrotic tissue was gradually cleared by irrigation of the purulent cavity with normal saline through the douche tube, and continuous drainage of the double cannula under a negative pressure. The drainage volume (difference between input and output), body temperature, white blood cell (WBC) counts, procalcitonin (PCT) and C-reactive protein (CRP) before and after treatment were monitored and recorded. Review abdominal CT examination was performed on one month after surgery to check the residual necrotic tissue around the pancreas.
Results: In the 23 SAP patients at infection stage and underwent the above treatment, the symptoms of infection or intoxication were all improved, the drainage volumes were significantly increased within postoperative day 30 compared with preoperative level (all P<0.05), and the infection indexes (body temperature, WBC count, PCT and CRP) were significantly decreased at different time points after operation compared with their preoperative levels (all P<0.05). About one month after the operation, the result of review CT examination showed peripancreatic necrosis tissue and collections had largely disappeared. Douche tube change was required in 5 patients due to drainage tube blockage at 2 weeks postoperatively. No complications such as abdominal hemorrhage, intestinal leakage or perforation occurred, and no minimally invasive surgical intervention or open surgery was required in any of them. Finally, all patients recovered and were discharged.
Conclusion: Necrotic pancreatic tissue removal through a small incision along the tract of PCD tube combined with percutaneous nephroscope has demonstrable clinical efficacy in treatment of SAP complicated with infected necrosis.
Keywords：
Pancreatitis
Acute Necrotizing; Debridement; Drainage; Minimally Invasive Surgical Procedures
Methods: In 23 SAP patients at infection stage after receiving poor treatment such as inadequate drainage, a small incision approximately 2 cm in length along the tract of the PCD tube was made, through which, the necrotic pancreatic tissue in the superficial areas was removed with a lithotomy forceps, and in the deep areas was cleared visually by baskets via the combined percutaneous nephroscope. A douche tube and a double cannula were respectively inserted in the superior area and the inferior area of the residual space after necrotic pancreatic tissue removal, and the tubes were then brought out through abdominal wall at relatively thin sites and secured in places. The previous incision wound of PCD tube was closed. After above operation, the residual necrotic tissue was gradually cleared by irrigation of the purulent cavity with normal saline through the douche tube, and continuous drainage of the double cannula under a negative pressure. The drainage volume (difference between input and output), body temperature, white blood cell (WBC) counts, procalcitonin (PCT) and C-reactive protein (CRP) before and after treatment were monitored and recorded. Review abdominal CT examination was performed on one month after surgery to check the residual necrotic tissue around the pancreas.
Results: In the 23 SAP patients at infection stage and underwent the above treatment, the symptoms of infection or intoxication were all improved, the drainage volumes were significantly increased within postoperative day 30 compared with preoperative level (all P<0.05), and the infection indexes (body temperature, WBC count, PCT and CRP) were significantly decreased at different time points after operation compared with their preoperative levels (all P<0.05). About one month after the operation, the result of review CT examination showed peripancreatic necrosis tissue and collections had largely disappeared. Douche tube change was required in 5 patients due to drainage tube blockage at 2 weeks postoperatively. No complications such as abdominal hemorrhage, intestinal leakage or perforation occurred, and no minimally invasive surgical intervention or open surgery was required in any of them. Finally, all patients recovered and were discharged.
Conclusion: Necrotic pancreatic tissue removal through a small incision along the tract of PCD tube combined with percutaneous nephroscope has demonstrable clinical efficacy in treatment of SAP complicated with infected necrosis.