经皮内镜坏死组织清创术治疗感染性胰腺坏死的疗效评价  

A preliminary efficacy evaluation for percutaneous endoscopic necrosectomy in treating infectious pancreatic necrosis

作　　者：黄华冰 王东[1] 谢静[1] 曾彦博[1] 董元航[1] 陈燕[1] 李兆申[1] 杜奕奇[1] 

机构地区：[1]第二军医大学长海医院消化内科,上海200433

出　　处：《中华胰腺病杂志》2017年第2期77-81,共5页Chinese Journal of Pancreatology

摘　　要：目的 评估经皮内镜坏死组织清创术（PEN）治疗感染性胰腺坏死（IPN）的疗效.方法 回顾性分析2015年12月至2016年9月第二军医大学长海医院收治的6例接受PEN治疗的IPN患者的各项临床资料,包括基本信息、病情评估、治疗方法和治疗次数,并将PEN治疗前后的生命体征和炎症指标进行比较.结果 6例IPN患者中重症急性胰腺炎（SAP）4例,中度重症急性胰腺炎（MSAP）2例.APACHEⅡ评分平均12.0分（10-15分）,MCTSI评分平均9.3分（8-10分）.6例患者共计进行13次PEN治疗,平均每例行2.2次（1-4次）,术后每例患者平均放置引流管2.5根（1-4根）,平均引流时间139 d（106-183 d）,平均住院时间116 d（48-223 d）.经PEN治疗,6例IPN患者病情均获明显好转,心率、体温及炎症指标下降,无出血等严重并发症,仅1例术后发生胰瘘,均未行开腹手术引流.但MCTSI评分越高的患者,PEN疗程、引流管数目增加,引流时间及住院时间延长.结论 PEN是治疗IPN的有效微创手术,但PEN疗程、留置引流管数、置管引流时间及住院时间均随着MCTSI评分升高而增加.Objective To evaluate the therapeutic effect of percutaneous endoscopic necrosectomy （PEN） in treating infectious pancreatic necrosis （IPN）.Methods A retrospective review of clinical data of 6 patients with IPN who received PEN in Changhai Hospital, Second Military Medical University from Dec 2015 to Sep 2016 was performed.Clinical parameters were recorded, including basic information, severity evaluation and therapeutic methods and times.In addition, vital sign parameters and inflammatory marks before and after PEN treatment were compared.Results There were 4 patients with severe acute pancreatitis （SAP） and 2 patients with moderately severe acute pancreatitis （MSAP） in these 6 patients with IPN.Mean APACHEⅡ score was 12 （10-15）, and mean MCTSI scores was 9.3（8-10）.All 6 patients received a total of 13 times PEN treatments, with a mean of 2.2（1-3） times.Each patient was treated with a mean of 2.5（1-4） drainage tubes placed in the peripancreatic abscess after PEN treatment, and the mean time for drainage was 139 d（106-183 d）.Besides, the mean hospitalization time was 116 d （48-223 d）.All the patients′ condition was improved significantly after PEN treatment, including reduced heart rate, body temperature and inflammatory markers, without bleeding or other serious complications.Only 1 patient had pancreatic fistula after treatment, and no patients needed open abdominal drainage surgery.Patients with higher MCTSI scores likely required more times of PEN and more drainage catheters, longer length of drainage and hospital stay.Conclusions PEN was safe and effective for treating patient with IPN, but those with higher MCTSI scores were associated with more PEN treatments, more drainage tubes, and longer time of drainage and hospitalization.

关 键 词：胰腺炎 急性坏死性 经皮内镜坏死组织清创术 外科手术 微创性 

分 类 号：R657.51[医药卫生—外科学]