胰周脓肿经超声介入穿刺联合胆道镜清创治疗36例经验总结  

Treatment of parapancreatic abscess with debridement by choledochoscope in combination with percutancous puncture drainage under ultrasound guidance： an analysis of 36 cases

作　　者：闫勇[1] 戴睿武[1] 汪涛[1] 汤礼军[1] 张炳印[1] 

机构地区：[1]成都军区总医院普通外科中心,610083

出　　处：《中华肝胆外科杂志》2011年第1期20-22,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的 探讨胰周脓肿治疗的新方法,创建微创治疗胰周脓肿理念,提高急性胰腺炎治愈率.方法 超声介入穿刺置管于脓肿内,采用Cook筋膜扩张器逐级扩张窦道至24F,通过胆道镜在直视下清除坏死组织、脓苔、反复冲洗至脓肿治愈.结果 36例胰周脓肿经超声介入穿刺联合胆道镜清创,33例治愈,治愈率91.7%,并发出血2例,肠外瘘3例,病死1例.结论 超声介入穿刺置管联合胆道镜清创治疗胰周脓肿,减少患者创伤,降低并发症和病死率.此方法操作简单,安全可靠,并发症少,治愈率高.Objective To explore a new method of parapancreatic abscess treatment and establish an idea of minimally invasive technologies for parapancreatic abscess to improve the recovery rate of acute pancreatitis. Methods The patients had experienced percutaneous puncture and placed drainage tube under the ultrasound guidance first, then the sinus tract was expanded gradually to 24F perimeter by Cook＇s fascia expender. Finally, the necrotic tissue and pyogenic membrane was removed and repeatedly washed under guidance of choledochoscopy. Results The recovery rate was 91.1 %（33/36）. The complication incidence was 10.7% （hemorrage：2 cases, external intestinal fistula：3 cases, and fatal MOF： 1 case）. Conclusions The viewpoint which parapancreatic abscess only can be cured by drainage operation can be changed by associating debridement by choledochoscope with percutaneous puncture drainage under the ultrasound guidance. It is a simple, safe and effective method. It can be used to reduce the patients＇ damage, complication and mortality and accomplish the idea of damage control by minimally invasive technologies.

关 键 词：胰周脓肿 超声介入 胆道镜 治愈率 

分 类 号：R657.5[医药卫生—外科学]