重症急性胰腺炎早期腹腔引流探讨  

Discussion of early peritoneal drainage for severe acute pancreatitis

作　　者：王卫[1] 吉敏[2] 周英豪[2] 李成林[2] 

机构地区：[1]安徽医科大学解放军306临床学院, 合肥230032 [2] 解放军306医院普通外科

出　　处：《临床外科杂志》2014年第5期341-343,共3页Journal of Clinical Surgery

摘　　要：目的：探讨重症急性胰腺炎（ severe acute pancreatitis，SAP）早期腹腔引流时机及引流方式选择。方法对32例重症急性胰腺炎患者采用B超或CT引导下经皮穿刺置管引流腹腔或胰周积液，同时予以生长抑素、抑酸、抗感染、保持水电解质及酸碱平衡、营养支持等综合治疗。结果32例患者中，3例因后期胰腺感染性坏死，引流管堵塞，行外科手术干预，2例治愈，1例术后因真菌感染死于多器官功能障碍综合征，另有3例置管引流患者死于相关并发症，共28例治愈，总治愈率为87.5％（28/32）；总病死率为12.5％（4/32）；引流时间7-60 d，平均28 d，引流次数1-4次。结论对于重症急性胰腺炎早期腹腔或胰周积液时，腹腔及小网膜囊内置管引流是一种安全有效的治疗方法，对于大部分选择恰当的病例，可以避免传统的手术引流。Objective To investigate the timing and method of early peritoneal drainage for se-vere acute pancreatitis（ SAP）. Methods A total of 32 SAP patients from January 2008 to June 2013 were enrolled. All patients received ultrasound or CT guided percutaneous catheter drainage of peritoneal or peripancreatic fluid collections. Meanwhile,patients were given somatostatin,antacids,antibiotics,maintai-ning water-electrolyte and acid-base balance,nutritional support and other comprehensive treatment. Re-sults In the 32 cases,3 patients received surgical intervention for infectious pancreatic necrosis and cath-eter blockage. Two cases were cured,but 1 patient died of MODS caused by fungal infection. Another 3 pa-tients with drainage died of related complications. A total of 28 patients were cured. The total curative rate was 87. 5%（28/32）and the overall mortality was 12. 5%（4/32）. The duration of drainage ranged from 7 to 60 days with an average of 28 days. The times of drainage ranged from 1 to 4 times. Conclusion Percu-taneous catheter drainage of the abdomen and lesser omental bursa is a safe and effective treatment for per-itoneal or peripancreatic fluid collections of SAP. It can avoid the traditional surgical drainage for most se-lected patients.

关 键 词：B超 CT 重症胰腺炎 急性坏死性 经皮穿刺引流 

分 类 号：R657.51[医药卫生—外科学]