腹腔镜早期手术联合清胰汤治疗重症急性胰腺炎临床分析  

Clinical analysis of early laparoscopy combined with Qingyi decoction in the treatment of severe acute pancreatitis

作　　者：刘继东[1] 阎玉矿[1] 廖红霞[1] 鲍兴[1] 辛乐[1] 

机构地区：[1]深圳市龙岗中心医院普通外科,深圳518116

出　　处：《山西医科大学学报》2014年第8期764-767,共4页Journal of Shanxi Medical University

基　　金：深圳市龙岗区科技卫生基金资助项目(ys2012195)

摘　　要：目的 探讨腹腔镜早期手术联合清胰汤治疗重症急性胰腺炎（SAP）的疗效. 方法 回顾分析我院2011-07～2013-12采用腹腔镜手术联合清胰汤治疗的24例非胆源性SAP患者的临床资料.患者均早期实施腹腔镜下腹腔灌洗引流术,腹腔镜下行胃结肠韧带切开,胰腺被膜切开减压,吸尽胰周渗液并清除坏死组织,在小网膜囊、胰周及盆腔等多处置入多孔引流管,术后持续灌洗引流.术后第2天经胃管注入清胰汤. 结果 24例腹腔镜手术均顺利完成.1例SAP病人因术后并发多器官功能衰竭（MOF）死亡,其余23例均痊愈出院.6例术后合并急性肾功能衰竭（ARF）,经腹膜透析液灌洗后肾功能完全恢复正常.1例出现胰瘘,经保守治疗痊愈.随访半年,发现假性胰腺囊肿1例,行囊肿-空肠吻合内引流术治愈.结论 腹腔镜早期手术联合清胰汤治疗SAP方法安全、有效,可减少并发症,降低死亡率,符合治疗SAP中损伤控制的理念.Objective To investigate the curative effect of early laparoscopy combined with Qingyi decoction in the treatment of severe acute pancreatitis（SAP）.Methods The clinical data of 24 patients with non-biliary SAP,who underwent laparoscopic surgery combined with Qingyi decoction,from July 2011 to December 2013 in our hospital were retrospectively analyzed.Patients underwent early laparoscopic peritoneal lavage and drainage,the procedure of opening the gastrocolic ligament,cutting the pancreatic capsule for decompression,eliminating the exudate near the pancreas and removing pancreatic necrosis tissues under laparoscope.Porous drainage catheters were placed around the omental bursa,pancreas and pelvic cavity for postoperative continuous lavage.Qingyi decoction was injected through gastric tube at 2 d after surgery. Results All surgeries were successful.Twenty-three patients with SAP were cured except one patient died of postoperative multiple organ failure（MOF）.Six patients had postoperative acute renal failure（ARF）,but their renal function returned to normal after peritoneal dialysis.One pancreatic fistula patient was cured after conservative treatment.After followed up for 6 months,one patient was found pancreatic pseudocyst and cured by internal drainage of pseudocystic-jejunostomy.Conclusion The procedure of early laparoscopy combined with Qingyi decoction for SAP is safe and effective,and can reduce the mortality and complications of SAP,which is consistent with the idea of damage control in the treatment of SAP.

关 键 词：腹腔镜 腹腔灌洗 重症急性胰腺炎 清胰汤 

分 类 号：R657.51[医药卫生—外科学]