经皮置管负压冲洗联合内镜引流治疗重症急性胰腺炎合并胰腺坏死组织感染  

Combination of percutaneous catheter drainage with negative pressure irrigation and endoscopicdrainage for severe acute pancreatitis patients with infected pancreatic necrosis

作　　者：童智慧[1] 王震龙[1] 李维勤[1] 李刚[1] 吴丛业[1] 邹磊[1] 周晶[1] 汪志明[1] 李宁[1] 黎介寿[1] 

机构地区：[1]南京大学医学院临床学院南京军区南京总医院普通外科,南京210002

出　　处：《中华胰腺病杂志》2013年第3期152-156,共5页Chinese Journal of Pancreatology

基　　金：国家自然科学基金青年项目（81200334）

摘　　要：目的观察经皮置管负压冲洗联合内镜引流（PCD＋NPI＋ED）治疗重症急性胰腺炎（SAP）合并胰腺坏死组织感染（IPN）的临床效果。方法回顾2011年7月至2012年7月经PCD＋NPI＋ED联合技术治疗的17例合并IPN的SAP患者的临床资料，分析临床治疗过程及预后。结果17例患者IPN确诊距发病时间为（26．9±7．9）d。13例革兰阴性菌感染，3例革兰阳性菌感染，1例侵袭性真菌感染。首次PCD＋NPI治疗距发病时间为（34．8±11．6）d。B超引导下置管1例，CT引导下置管8例，B超和CT联合引导下置管8例，每例患者平均所置负压冲洗引流管为（3．5±1．2）根。首次ED治疗距首次PCD＋NPI时间为（26．7±9．6）d，每例患者平均ED治疗（2．1±0．9）次。2例中转剖腹手术引流，距确诊IPN时间分别为24d和56d。17例患者均无PCD＋NPI置管相关并发症发生，第1例患者在ED治疗过程中发生出血，ED治疗后2例并发十二指肠瘘，1例并发高位空肠瘘，1例并发降结肠瘘，2例腹腔出血。无新发脏器功能障碍和脓毒血症。1例在PCD＋NPI＋ED联合治疗前即并发多器官功能不全和脓毒血症，虽中转剖腹手术引流仍无法有效控制脓毒血症而病死。结论PCD＋NPI＋ED联合技术可使IPN患者避免剖腹手术引流，减少并发症发生，改善患者预后。Objective To investigate the effectiveness of combining percutaneous catheter drainage （PCD）, negative pressure irrigation （NPI） with endoscopic drainage （ED） for severe acute pancreatitis （SAP） patients with infected pancreatic necrosis （IPN）. Methods The clinical data of 17 patients with IPN admitted from July 2011 to July 2012 were reviewed and the clinical course and outcome were analyzed. All the patients were treated with PCD ＋ NPI ＋ ED. Results The time interval from onset of the disease to IPN diagnosis was （26.9 ± 7.9 ） days. Thirteen cases were infected with gram-negative bacterium, 3 cases with gram-positive bacterium and 1 case with invasive fungal. The time interval from onset to first PCD ＋ NPI was （ 34.8 ± 11.6） days. Eight cases were treated with CT guidance, 1 case with ultrasound guidance and 8 cases with both. The mean number of double catheterization cannulas in every patient was 3.5 ± 1.2. The time interval from first PCD ＋ NPI to first ED was （ 26.7 ＋ 9.6 ） days and the mean ED treatment of every patient was （2.1±0.9） times. Among all patients, two were converted to open surgery and the time intervals from disease onset to operation in these two patients were 24 days and 56 days respectively. No catheterization related complication occurred in these 17 cases. Bleeding occurred in the first patient during the procedure of ED. After ED, duodenal fistula occurred in 2 patients, jejunal fistula occurred in 1 patient, descending colonfistula occurred in I patient, abdominal cavity bleeding occurred in 2 patients. No new cases of organ dysfunction and sepsis occurred. One patient developed muhiple organ dysfunction and sepsis before PCD ＋ NPI ＋ ED treatme,lt, though this patienl underwent laparotomy, sepsis was not controlled and this patient died eventually. Conclusions Combination of PCD ＋ NPI ＋ ED can effectively avoid operation for most patients with IPN, and decrease complication rates and improve the prognosis of patients.

关 键 词：胰腺炎 急性坏死性 经皮置管引流 内镜引流 手术引流 

分 类 号：R576[医药卫生—消化系统]