多元化微创技术在重症急性胰腺炎治疗中的应用  

Clinical application of multiple minimally invasive techniques for the treatment of severe acute pancreatitis

作　　者：孙备[1] 贾光[1] 王刚[1] 李军[1] 谭宏涛[1] 刘杰[1] 武林枫[1] 姜洪池[1] 

机构地区：[1]哈尔滨医科大学附属第一医院胰胆外科,150001

出　　处：《中华消化外科杂志》2011年第5期338-340,共3页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金（81170431,81100314）;黑龙江省杰出青年基金（JC200717）;黑龙江省科技厅攻关项目（GC09C407-2）

摘　　要：目的探讨多元化微创技术在重症急性胰腺炎（SAP）治疗中的临床应用价值。方法回顾性分析2005年1月至2010年7月哈尔滨医科大学附属第一医院收治的93例接受微创治疗的SAP患者的临床资料，根据患者的病情，分别采用超声引导下经皮穿刺置管（PCD）、ERCP、EST和（或）ENBD、腹腔镜等治疗，总结其临床疗效。结果本组患者在综合治疗的基础上联合1种微创技术治疗32例，2种微创技术治疗41例，3种微创技术治疗14例，4种微创技术治疗6例。69例患者施行超声引导下PCD；28例施行ERCP、EST和（或）ENBD；29例施行腹腔镜手术；19例施行分阶段处理；4例发生腹腔出血并发症的患者施行介入治疗。本组患者平均腹痛缓解时间为（37±18）h；平均住院时间为（31±21）d；胰周感染发生率为62％（58／93）；中转开腹率为4％（4／93）；治愈率为91％（85／93）；病死率为9％（8／93）。结论采用多种微创技术联合个体化治疗，可明显提高SAP的治愈率。Objective To evaluate multiple minimally invasive techniques in the treatment of severe acute pancreatitis （SAP）. Methods The clinical data of 93 patients with SAP who received minimally invasive treatment at the First Affiliated Hospital of Harbin Medical University from January 2005 to July 2010 were retrospectively analyzed. Pereutaneous catheter drainage （PCD）, endoscopic retrograde eholangio-pancreatography （ERCP）, endoscopic sphincterotomy （EST）, endoscopic nasabiliary drainage （ENBD） and laparoseopy were applied according to the condition of the patients. The effieaeies of different treatment methods were evaluated. Results On the basis of comprehensive treatment, 32 patients received 1 kind of minimally invasive treatment, 41 patients received 2 kinds of minimally invasive treatment, 14 patients received 3 kinds of minimally invasive treatment and 6 patients received 4 kinds of minimally invasive treatment. Sixty-nine patients received ultrasoundguided PCD; 28 patients received ERCP, EST and （or） ENBD; 29 patients received laparoseopy; 19 patients received treatments with stepped approach; 4 patients were complicated with abdominal bleeding, and received interventional treatment. The mean time of abdominal pain relief and duration of hospital stay were （37 ± 18 ）hours and （31 ±21 ）days, respectively. The abdominal infection rate, laparotomy transfer rate, curative rate and mortality rate were 62% （58/93）, 4% （4/93）, 91% （ 85/93 ） and 9% （ 8/93 ）, respectively. Conclusion Multiple minimally invasive techniques combined with individualized treatment may significantly improve the curative rate of SAP.

关 键 词：重症急性胰腺炎 微创技术 治疗 

分 类 号：R657.51[医药卫生—外科学]