动态监测胃黏膜内pH值对胆源性胰腺炎外科治疗的价值  

Dynamic monitolling of pHi in surgical treatment of biliary pancreatitis.

作　　者：梁建深[1] 吴一武[1] 钟能锭[1] 索南仁青[1] 翁泽滨[1] 陈松[1] 

机构地区：[1]中山大学附属第五医院普外科,广东省珠海市519000

出　　处：《中国综合临床》2007年第8期723-724,共2页Clinical Medicine of China

摘　　要：目的探讨胃黏膜内pH值对胆源性胰腺炎病情预后评估及在决定手术治疗中应用的价值。方法对确诊的146例胆源性胰腺炎患者经鼻插入胃黏膜二氧化碳张力计(TRIP-NGS导管)测定胃黏膜内pH值,每隔12小时测定一次,并进行APACHEⅡ评分,将2组数据与外科治疗进行相关分析。结果①pH值变化反映胆源性胰腺炎病情发展变化,与器官衰竭数呈负相关;②外科干预治疗与内科治疗比较差异有统计学意义(P<0.05);③pH≥7.25与pH<7.25患者开腹手术病死率和细茵培养阳性率比较差异有统计学意义(P<0.05)。结论pH值对胆源性胰腺炎外科治疗有指导意义。外科处理原则是:①胆道无梗阻,以内科保守治疗为主;②伴胆道梗阻,先行经内镜十二指肠乳头括约肌切开术、经内镜鼻胆管引流术、B超导引引流、腹腔灌洗等,如胆道引流不畅或pH值持续下降,则开腹手术。Objective To evaluate the dynamic monitouing of the pHi in gastric mucosa for judgement of prognosis and the determination of surgical treatment for biliary pancreatitis. Methods The pHi in gastric mucosa of 146 patients with definite biliary pancreatitis was detected by using pernasal TRIP-NGS pipe per 12 hours, and the APACHE Ⅱ score was conducted. The correlation analysis between those data and the surgical treatment was made. Results （1）The variation of pHi reflected the progression of the biliary pancreatitis and was negatively correlated with the organ failure; （2）The difference between surgical treatment and medical treatment was significant （P 〈0.05 ） ;（3）The difference of positive rate of bacterial culture and the operative mortality rate was significant between the two sets of patients with pHi ≥7.25 and pHi 〈 7.25 { P 〈 0.05 ）. Conclusion pHi is instructionally significant for the surgical treatment of biliary pancreatitis. The surgical treatment principal is （1）If there is no biliary obstruction,medical treatment is the first choice; （2）If there is biliary obstruction, drainage of the peritoneal lavage guided by EST, ENBD or ultrasound should be made first, but tot the patients with biliary tract drainage is inadequate or pHi descending, to laparotomy will be necessary.

关 键 词：胆源性胰腺炎 胃黏膜PH值 外科治疗 

分 类 号：R657.5[医药卫生—外科学]