重症急性胰腺炎腹腔镜术后冲洗及引流策略  

Irrigation and drainage strategy in severe acute pancreatitis after laparoscopic surgery

作　　者：张炎祥[1] 陈小伍[1] 朱达坚[1] 剧永乐[1] 陆光生[1] 耿岩[1] 周围[1] 

机构地区：[1]南方医科大学附属顺德第一人民医院普通外科,顺德528300

出　　处：《中华腔镜外科杂志（电子版）》2016年第6期351-353,共3页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：广东省医学科研基金资助(A2016443);佛山市卫生和计生局医学科研立项(20160249)

摘　　要：目的探讨重症急性胰腺炎(severe acute pancreatitis,SAP)腹腔镜术后冲洗及引流策略。方法回顾性分析南方医科大学附属顺德第一人民医院2007年1月至2015年12月期间采用腹腔镜手术治疗的54例非胆源性SAP的患者临床资料,全部患者均应用腹腔镜微创技术行胃结肠韧带切开,胰腺被膜切开减压,吸除胰周积液及清除坏死组织,在胰周留置多条引流管,术后采用多种灌洗及引流策略并观察疗效。结果治愈50例,4例死亡,其中1例死于合并胰腺癌,2例死于迟发腹腔出血,1例死于多器官功能衰竭。术后冲洗时间(21.6±14.5)d,引流管拔除时间(35.4±22.4)d,术后住院时间(38.7±24.6)d。其中1例术后32 d因胰周脓肿再次行腹腔镜手术,3例胰腺假性囊肿,1例保守治疗治愈,2例经穿刺引流后治愈。结论 SAP腹腔镜手术后,合理的冲洗及引流策略,可降低SAP的病死率,减少并发症。Objective To investigate the irrigation and drainage strategy in severe acute pancreatitis after laparoscopic surgery. Methods The clinical data of 54 patients with non-biliary SAP and underwent the laparoscopic surgery from Jan. 2007 to Dec. 2015 were retrospectively analyzed. Using laparoscopic surgery, laparoscopic colon separated ligament stomach, pancreas into the omentum cavity exposed, the net absorption of exudate, peritoneal washing, remove pancreatic necrosis, in the lesser sac, pancreatic and pelvic placement lavage a plurality of drainage pipe and tube, after surgery using a variety of methods for subsequent irrigation and drainage. Results 50 cases was cured, 4 cases were died, in which 1 case died with pancreatic cancer, 2 cases died with delayed abdominal bleeding, 1 case died with multiple organ failure. The time of flushing was（21.6 ± 14. 5 ） d ,and the time of drainage tube extraction was（ 35. 4±22.4） d. The hospitalization time was （38. 7 ± 24. 6） d. 1 case was underwent the second laparoscopic surgery in 32 d after the first operation because of pancreatic abscess, 3 cases became to pancreatic pseudocyst. 1 case was cured with conservative treatment. 2 cases were cured after puncture and drainage. Conclusions Reasonable irrigation and drainage strategy after laparoscopic surgery can reduce mortality and reduce complications in SAP.

关 键 词：重症急性胰腺炎 腹腔镜 手术 引流 

分 类 号：R657.51[医药卫生—外科学]