早期微创手术与保守疗法治疗重症胰腺炎的临床对比研究  

Comparison of Early Minimally Invasive Surgical Procedures and Conservative Treatment in Severe Pancreatitis

作　　者：李明非[1] 曾勇[2] 关华[1] 甘险峰[1] 

机构地区：[1]四川省人民医院肝胆外科,体检中心,四川成都610072 [2]四川大学华西医院,四川成都610041

出　　处：《四川医学》2016年第7期744-747,共4页Sichuan Medical Journal

摘　　要：目的对我院重症胰腺炎(SAP)患者进行回顾性分析,探讨早期微创手术治疗和保守治疗在SAP中的临床疗效。方法选择我院2013年1月至2015年1月收治的60例SAP患者作为研究对象,随机分组为观察组和对照组,每组各30例。对照组采用保守治疗方法,观察组早期给予微创手术治疗,比较两组患者的治疗前、治疗后实验室指标值、治疗效果和并发症情况。结果 1观察组血清淀粉酶、尿淀粉酶、白细胞计数、血糖值治疗后分别为:(105.8±36.5)U/L、(320.5±250.5)U/L、(6.5±1.5)/mm^3、(4.9±0.5)mmol/L,明显高于治疗前,差异有统计学意义(P<0.01);对照组血清淀粉酶、尿淀粉酶、白细胞计数、血糖值治疗后分别为(180.5±30.5)U/L、(390.9±280.9)U/L、(9.5±1.5)/mm^3、(6.5±0.8)mmol/L,观察组治疗后明显高于对照组治疗后(P<0.05)。2对照组治疗有效率为47%,观察组治疗有效率为97%。与对照组对比,观察组治疗有效率明显更高,两组数据的比较差异有统计学意义(P<0.05)。3观察组腹腔感染、胰腺周围感染、浓毒血症病例分别为1例、2例、1例,对照组腹腔感染、胰腺周围感染、浓毒血症病例分别为6例、8例、6例。与对照组对比,观察组并发症发生率明显更低,两组数据的比较差异有统计学意义(P<0.05)。4观察组腹痛、腹胀、排便缓解的时间分别为(3.0±0.5)d、(3.2±0.8)d、(4.0±1.5)d,对照组腹痛、腹胀、排便缓解的时间分别为(6.0±1.5)d、(6.9±0.9)d、(9.0±0.8)d。与对照组对比,观察组症状缓解的时间明显更短,两组数据比较差异有统计学意义(P<0.05)。结论在SAP治疗中,早期微创手术比保守疗法具有更理想的疗效,值得临床应用;但必须满足一定的手术适应症,以及严格掌握手术时机。Objective We retrospectively analyzed patients with severe pancreatitis in the hospital to evaluate the efficacy of early minimally invasive surgical procedures and conservative treatment in severe pancreatitis. Methods 60 patients with severe pancreatitis in the hospital from January 2013 to January 2015 were equally randomized into observation and control group. Patients in the control group received conservative treatment,while patients in the observation group received early minimally invasive surgery. Laboratory indexes,treatment efficacy and complications incidence of the two groups before and after treatment were compared. Result 1Posttreatment serum amylase,urine amylase,white blood cell count,blood glucose level in the observation group were（ 105. 8±36. 5） U / L、（ 320. 5 ±250. 5） U / L、（ 6. 5 ±1. 5） / mm^3、（ 4. 9±0. 5） mmol/L respectively and were higher than those before treatment with statistic significance（ P〈0. 01）. And the posttreatment serum amylase,urine amylase,white blood cell count,blood glucose level in the control group were（ 180. 5 ±30. 5） U / L、（ 390. 9 ±280. 9） U / L、（ 9. 5 ±1. 5） / mm^3、（ 6. 5±0. 8） mmol/L respectively. All indexes in the observation group were significantly higher than those in the control group（ P〈0. 05）. 2The effective rate in the observation group was higher than that in the control group（ 97% vs. 47%,P〈0. 05）. 3The incidence rate in the two groups of abdominal infection,peripancreas infection and septicopyemia also demonstrated statistic significance（ 1 vs. 6,2 vs.8,1 vs. 6,P〈0. 05）. 4The remission time of abdominal pain and distension,the time to defecation were respectively（ 3. 0±0. 5）d,（ 3. 2±0. 8） d,（ 4. 0±1. 5） d in the observation group. And those in the control group were（ 6. 0±1. 5） d,（ 6. 9 ±0. 9） d,（ 9. 0 ±0. 8） d respectively. And patients in the observation group needed less time to remit from the disease（ P〈0. 05）. Conclusion Early minimally in

关 键 词：早期治疗 微创手术 保守疗法 重症胰腺炎 临床分析 

分 类 号：R657.51[医药卫生—外科学]