腹膜后入路视频辅助下小切口坏死组织清除术治疗胰腺感染性坏死的体会  

Experience of minimal-access video-assisted retroperitoneal debridement in treatment of infected pancreatic necrosis

作　　者：冯健[1] 刘志伟[1] 蔡守旺[1] 焦华波[1] 杜俊东[1] 辛宪磊[1] 陈继业[1] 王鹏飞[1] 何蕾[1] 卢实春[1] 肖越勇[1] 王茂强[1] 

机构地区：[1]解放军总医院肝胆外科,北京100853

出　　处：《中华外科杂志》2016年第11期844-847,共4页Chinese Journal of Surgery

摘　　要：目的 总结腹膜后入路视频辅助下小切口坏死组织清除术治疗胰腺感染性坏死的体会.方法 回顾性分析2008年6月至2013年6月在解放军总医院肝胆外科和解放军总医院第一附属医院肝胆外科采用视频辅助下小切口坏死组织清除术治疗的12例胰腺感染性坏死患者的临床资料.男性10例,女性2例;年龄33～ 55岁,平均（43±8）岁;所有患者均有重症急性胰腺炎严重并发症——胰腺感染性坏死,其中2例为早期穿刺置管引流术（PCD）后感染,10例为自发感染.小切口治疗策略通常为三步法：CT引导下的PCD、腰部小切口切开视频辅助下的坏死组织清除术、术后冲洗引流.结果 所有患者均接受视频辅助下小切口胰周坏死组织清除术.10例术前行PCD,PCD治疗时间为发病后8～86 d（平均24 d）.视频辅助下小切口手术在PCD治疗后的3～29 d（平均18d）施行.4例接受1次清除术,3例接受2次,3例接受3次,1例接受4次手术,1例接受9次手术.术后发生结肠瘘3例,腹腔出血5例,胰瘘2例,糖尿病1例;死亡3例.结论 视频辅助下小切口技术清除胰腺感染性坏死组织效率较高,但也存在一些不足,外科干预时机应尽可能推迟.Objective To explore the experience of minimal-access video-assisted retroperitoneal debridement in treatment of infected pancreatic necrosis （IPN）.Methods A retrospective review was performed on 12 patients with IPN who underwent minimal-access video-assisted retroperitoneal debridement between June 2008 and June 2013 in People＇s Liberation Army General Hospital and First Affiliated Hospital of People＇s Liberation Army General Hospital,respectively.There were 10 male patients and 2 female patients aging from 33 to 55 years with mean age of（43±8） years.Pancreas infective necrosis,the serious complications of severe acute pancreatitis occurred in all of the patients among which there were 2 patients with infection after percutaneous catheter drainage （PCD） in early phase of disease,and 12 patients with spontaneous during the late phase.The technical strategies of the minimally invasive treatment mainly included PCD,minimal-access video-assisted retroperitoneal debridement,and irrigation.Results Ten patients received PCD and the median time from onset of acute necrotizing pancreatitis to PCD was mean of 24 days（range 8-86 days）.Minimal-access video-assisted retroperitoneal debridement was performed after 18 days（range 3-29 days） after PCD.Three patients died after surgery.Five patients had hemorrhage complication and 3 had colonic fistula.Pancreatic fistula occurred in 2 patients.Conclusions The technique of minimal-access video-assisted retroperitoneal debridement has advantage and some minor disadvantage.Delayed minimal-access video-assisted retroperitoneal debridement is recommended.

关 键 词：胰腺炎 急性坏死性 外科手术 微创性 视频辅助下小切口 肾镜 胰腺感染性坏死 

分 类 号：R657.51[医药卫生—外科学]