“π入路”胰腺坏死组织清除术的疗效分析  

Efficacy of necrosectomy with a “π approach” for necrotizing pancreatitis

作　　者：杨明[1] 吴河水[1] 熊炯炘[1] 赵刚[1] 周峰[1] 陶京[1] 杨智勇[1] 郭尧[1] 殷涛[1] 王春友[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院胰腺外科

出　　处：《临床外科杂志》2015年第1期27-29,共3页Journal of Clinical Surgery

摘　　要：目的：探讨“π入路”坏死组织清除术治疗坏死性胰腺炎的临床疗效。方法回顾性分析采用“π入路”坏死组织清除术治疗32例坏死性胰腺炎患者的临床资料。手术通常选择上腹部正中或经腹直肌切口进腹。坏死病灶的暴露采用胃结肠韧带横切口联合升结肠与降结肠内侧后腹膜纵切口方式，即“π入路”法。该入路充分暴露胰腺炎的“马蹄形”坏死区后，尽量于直视下手指清除坏死物，组织间隙内残余坏死物可用器械清除。结果术中坏死物培养确定感染者22例（68.8%），无菌性坏死10例（31.2%）。术后无并发腹腔出血者。总体并发症发生率为25%（8/32），其中伤口感染3例（9.4%），胰瘘4例（12.5%），肠瘘1例（3.1%）。2例（6.3%）再手术，1例术后残余感染再次行坏死组织清除术，1例4个月后并发胰源性门静脉高压症行介入下脾动脉栓塞术。术后死亡2例（6.3%），1例肠瘘，并发多系统器官功能衰竭死亡；1例残余感染，并发呼吸功能衰竭，术后4个月死于脑血管意外。结论坏死性胰腺炎患者行“π入路”坏死组织清除术能有效降低腹腔出血等并发症的发生率及再手术率。Objective To investigate the clinical efficacy of necrosectomy with“π approach”for the treatment of necrotizing pancreatitis. Methods The clinical data of 32 patients with necrotizing pan-creatitis who received necrosectomy with“π approach”were retrospectively analyzed. Operations were typi-cally performed via an upper midline incision or upper transrectal incision. The necrosis was approached through the transverse incision on gastrocolic ligament combined with retroperitoneal longitudinal incisions in the medial of the ascending and descending colon,named“π approach”by us. This approach fully ex-posed pancreatic and peripancreatic horseshoe-shaped necrosis. Debridement was comprehensively carried out as far as possible by digit under direct vision,and the residual necrosis in the interspaces could be re-moved by instruments. Results A total of 22 patients（68. 8% ）had infected necrosis based on intraopera-tive culture and 10 patients（31. 2% ）had sterile necrosis. There was no patient complicated with intra-ab-dominal hemorrhage after operation. The overall complication rate was 25%（8 / 32）. Three patients （9. 4% ）were complicated with wound infection,four（12. 5% ）with pancreatic fistula and one with intesti-nal fistula（3. 1% ）. There were two cases（6. 3% ）of reoperation. One of them need necrosectomy again be-cause of residual infection and the other one complicated with pancreatogenic portal hypertension under-went interventional embolization of splenic artery at the 4th month after operation. Two patients died （6. 3% ）after operation. One of them complicated with intestinal fistula and died of multiple system organ failure;the other patient occurred residual infection and respiratory failure and died of a cerebrovascular accident at the 4th month after operation. Conclusion For necrotizing pancreatitis,the operation via“πapproach”can effectively reduce intraperitoneal hemorrhage rate and reoperation rate.

关 键 词：急性胰腺炎 坏死组织清除术 手术入路 

分 类 号：R657.5[医药卫生—外科学]