经腹膜后入路微创治疗重症急性坏死性胰腺炎（附21例报告）  

Minimally Invasive Retroperitoneal Approach in the Treatment of Servere Acute Necrotic Pancreatitis：21 Cases Report

作　　者：谢于[1] 郑慧瑛 胡文炜[1] 王瑞玲[1] 孙强[1] 

机构地区：[1]第二炮兵总医院肝胆胃肠病研究所,北京100088 [2]第二炮兵后勤部门诊部,北京100045

出　　处：《中国现代手术学杂志》2014年第2期104-107,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨经腹膜后入路微创治疗重症急性坏死性胰腺炎的方法与疗效。方法2008年6月-2012年9月采用经腹膜后入路微创治疗重症急性坏死性胰腺炎21例，其中采用经腹膜后入路cT引导下穿刺引流6例；经腹膜后入路CT引导下穿刺引流、肾镜坏死组织清除术15例。结果本组21例均顺利完成微创手术治疗，无手术死亡病例。行经腹膜后入路CT引导下穿刺引流治疗的6例患者，术后引流通畅，恢复良好，无术后并发症的发生，术后拔管时间平均（8．2±2．1）d。行经腹膜后入路CT引导下穿刺引流＋肾镜坏死组织清除术的15例患者中，接受1次手术者4例，2次手术者9例，3次手术者2例。其中术后1d出血1例，术后7d出现结肠瘘1例，术后6月出现假性囊肿1例，均行保守治疗治愈，拔管时间平均（15．2±3．1）d。结论对于合适的病例，腹膜后入路CT引导下穿刺引流或经腹膜后入路CT引导下穿刺引流＋肾镜坏死组织清除术治疗重症急性坏死性胰腺炎是安全、有效的微创治疗方法，具有创伤小、易于重复施行及引流效果好的优点。Objective To explore the method and effect of minimally invasive retroperitoneal approach treatment for severe acute necrotic pancreatitis. Method A total of 21 severe acute necrotic pancreatitis patients admitted from June 2008 to September 2012 were performed minimally invasive treatment via retroperitoneal approach, including 6 eases of pereutaneous catheter drainage （PCD） under CT guidance and 15 cases of PCD combined pancreatic neeroseetomy （PN） under nephroseope. Results All cases were completed the surgery without peri-operative death. In the 6 case of PCD, unobstructed drainage and well recovery were achieved without post-operative complications, and the average extubation time was 8.2 ± 2. 1 days. In the 15 cases received PCD ＋ PN, 4 cases were carried out the operation only once, 9 cases were twice and 2 cases were three times. Among them, postoperative hemorrhage was found in 1 case one day after the operation, Colonic fistula in 1 case 7 days after the operation and pseudocyst in 1 case 6 months after the operation, and all were cured by expectant treatment. And the average extubation time was 15.2 ± 3.1 days. Conclusion The treatment of PCD or combined PN via retroperitoneal approach is safe and effective for severe acute necrotic pancreatitis with advantages as mini-invasion, repeatable easily and well drainage when the indication and occasion are suitable.

关 键 词：胰腺炎 急性坏死性 入路 腹膜后 胰腺坏死组织清除术 引流 

分 类 号：R657.51[医药卫生—外科学]