超声引导下经皮穿刺引流对重症急性胰腺炎的精准治疗  

Ultrasound-guided Percutaneous Catheter Drainage: A Precious Therapy in Severe Acute Pancreatitis

作　　者：王国涛[1] 刘明辉[1] 杨谢青 刘洁玉[1] 赵白桦[1] 

机构地区：[1]中南大学湘雅二医院超声科,湖南长沙410011

出　　处：《现代生物医学进展》2017年第17期3302-3305,共4页Progress in Modern Biomedicine

基　　金：湖南省自然科学基金项目(12JJ3102)

摘　　要：目的:评价超声引导下经皮穿刺置管引流(PCD)治疗重症急性胰腺炎(SAP)的安全性及临床疗效。方法:回顾性分析2011年1月-2015年12月在超声引导下经皮穿刺置管引流的273例SAP患者的临床资料,比较患者引流前后外周血白细胞(WBC)、血清白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平的变化。结果:273例患者中,131例患者仅经过PCD术后治愈出院;103例患者行超声引导下PCD术后全身症状得到明显改善,后期再采用经腹膜后内镜下清创术治愈出院,39例患者无好转,中转为开腹手术,PCD术的成功率为100%。103例经内镜下清创的患者中2例死亡,39例无好转的开腹手术患者中13例死亡。患者引流后外周血白细胞(WBC)、血清白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平均较引流前显著降低,差异有统计学意义(P<0.05)。结论:采用超声引导下的经皮穿刺置管引流治疗SAP具有定位准确、创伤小的有点,可使部分患者免于手术,或者为后续治疗创造有利条件,临床疗效显著。Objective： To evaluate the safety and effects of ultrasound-guided percutaneous catheter drainage （PCD） in the treatment of severe acute pancreatifis （SAP）. Methods： The clinical data of 273 cases of SAP patients undergoing ultrasound-guided percutaneous catheter drainage treatment from January 2011 to December 2015 were retrospectively analyzed. The levels of peripheral blood white blood cells （WBC）, IL-6, C-reactive protein （CRP）, serum TNF-ot before and after the drainage were compared between two groups. Results： Ultrasound-guided percutaneous catheter drainage was performed on all 273 patients. 131 patients were cured by ultra- sound-guided percutaneous catheter drainage only and the systemic symptom of 103 patients were improved significantly and they were cured by the following-up retroperitoneal endoscopic necrosectomy. While progression of disease was found in 39 patients, they were di- rectly converted to open operation finally. All the patients were performed successfully. Two patients died after the following-up retroperitoneal endoscopic necrosectomy. 13 patients of the open operation were died. After drainaging, the levels of peripheral blood white blood cells （WBC）, IL-6, C-reactive protein （CRP） and serum TNF-α dropped dramatically compared with those before the drainage（P〈0.05）. Conclusions： Ultrasound-guided percutaneous catheter drainage was an effective method with less trauma and precious positioning for SAP. With successful Ultrasound-guided percutaneous catheter drainage, patients could be free from operation or create an ideal surrounding for the following-up treatment.

关 键 词：超声引导 经皮穿刺引流 重症急性胰腺炎 

分 类 号：R576[医药卫生—消化系统]