CT引导下经皮穿刺引流与直接开腹术引流治疗胰腺坏死组织感染的疗效  

Clinical effect of CT-guided percutaneous catheter drainage versus laparotomy in treatment of infective pancreatic necrosis

作　　者：周祥慧[1] 陈欧[1] 罗彬[1] 古今[1] 邱雄[1] 邵泽勇[1] 

机构地区：[1]四川省雅安市人民医院,四川省雅安市625000

出　　处：《世界华人消化杂志》2013年第30期3291-3295,共5页World Chinese Journal of Digestology

摘　　要：目的:观察CT引导下经皮穿刺置管引流与直接开腹手术引流治疗重症急性胰腺炎(severe acute pancreatitis,SAP)合并胰腺坏死组织感染的疗效.方法:回顾性分析2009-01/2012-12四川省雅安市人民医院收治的SAP合并胰腺坏死组织感染患者45例的临床资料;根据首先采取的治疗方法的不同,将患者分为CT引导下经皮穿刺置管引流组与直接开腹手术引流组,其中经皮穿刺引流组21例,直接开腹手术引流组24例.CT引导下经皮穿刺置管引流,冲洗3 d后评价引流效果,无明显好转则中转开腹引流手术;直接开腹手术引流组在确诊感染后直接开腹引流.结果:CT引导下经皮穿刺引流组与直接开腹手术引流组比较,避免开腹手术引流率(42.3%vs 0)、一次开腹手术成功率(91.7%vs 66.7%,P<0.05)、术后残余脓肿发生率(8.3%v s33.3%,P<0.05)及新发脏器功能障碍率(9.5%vs 37.5%,P<0.05)均有明显差异,差异有统计学意义;而两组患者住院时间(46.71 d±10.96d vs 55.93 d±11.54 d,P<0.05)和住院费用(181872元±42011元vs 2510000元±57365元,P<0.05)相比,差异有统计学意义.结论:CT引导下经皮穿刺引流能有效降低开腹手术率,增加一次开腹手术成功率,能降低术后残余脓肿及新发脏器功能障碍的发生率;同时能减少患者住院时间和住院费用.AIM： To compare the clinical effect of CT-guided percutaneous catheter drainage versus laparotomy in the management of infective pancreatic necrosis. METHODS： Clinical data for 45 SAP patients with infective pancreatic necrosis who were treated from January 2009 to December 2012 were analyzed retrospectively. These patients were divided into two groups based on the treatment choice. Twenty-one patients in the percutaneous drainage group underwent CT-guided percutaneous catheter drainage, and the efficacy was evaluated after 3 d. If no improvement was achieved, they would receive laparotomy. Twenty-four patients in the laparotomy group received surgical drainage when the diagnosis of infective pancreatic necrosis was confirmed. RESULTS： Approximately 42.3% of patients in the percutaneous drainage group did not require laparotomy. The percutaneous drainage group had a significantly higher success rate of first laparotomy （91.7% vs 66.7%, P 〈 0.05）, significantly lower rates of postoperative residual abscess （8.3% vs 33.3%, P 〈 0.05） and new organ dysfunction （9.5% vs 37.5%, P 〈 0.05）, shorter hospital duration （46.71 d ± 10.96 d vs 55.93 d ± 11.54 d, P 〈 0.05） and less expenditure （181872 yuan ± 42011 yuan vs 2510000 yuan ± 57365 yuan, P 〈 0.05）. CONCLUSION： CT-guided percutaneous catheter drainage can effectively reduce the use of laparotomy, improve the success rate of first laparotomy, and decrease the rate of postoperative residual abscess and new organ dysfunction as well as the cost of medical resources.

关 键 词：CT引导 经皮穿刺引流 开腹术引流 胰腺坏死组织感染 

分 类 号：R657.5[医药卫生—外科学]