危重型急性胰腺炎的治疗趋势和结局变化  

The trends in surgical treatment and the outcomes of critical acute pancreatitis

作　　者：林嘉晏 申鼎成 黄耿文[1] 曹昕彤 宁彩虹 周书毅 纪连栋[1] 魏伟[1] 刘志勇[2] Lin Chiayen;Shen Dingcheng;Huang Gengwen;Cao Xintong;Ning Caihong;Zhou Shuyi;Ji Liandong;Wei Wei;Liu Zhiyong(Department of Biliopancreatie Surgery,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院胰胆外科,长沙410008 [2]中南大学湘雅医院重症医学科,长沙410008

出　　处：《中华肝胆外科杂志》2018年第9期622-624,共3页Chinese Journal of Hepatobiliary Surgery

基　　金：吴阶平医学基金会临床科研专项资助基金（320.6750.17518）;中南大学湘雅医院管理研究基金（2016GL12）

摘　　要：目的研究危重型急性胰腺炎（CAP）的治疗趋势和结局变化。方法回顾性分析2010年1月至2017年12月中南大学湘雅医院胰胆外科连续收治的76例CAP患者资料，对比2010—2013年（19例）与2014—2017年（57例）患者的细菌耐药情况、外科干预方法以及患者病死率。结果2010—2013年胰周引流液多重耐药菌（MDRO）比例为5．3％（1／19）。2014—2017年胰周引流液MDRO比例为50．9％（29／57），明显高于2010-2013年，差异有统计学意义（P〈0．05）。外科治疗方面，2014—2017年微创手术比例较2010-2013年明显升高，其中经皮穿刺置管引流（PCD）比例由63．2％上升至86．0％，微创入路腹膜后胰腺坏死组织清除术（MARPN）比例由0上升至59．6％，而开腹胰腺坏死组织清除术（OPN）的比例则由68．4％降至24．6％，差异有统计学意义（P〈0．05）。2010—2013年CAP患者的病死率为52．6％，2014-2017年下降至24．6％，差异有统计学意义（P〈0．05）。结论在CAP治疗中，虽然细菌耐药问题日益突出，但由于各种微创技术的开展，CAP的病死率呈明显下降趋势。Objective To study the trends in surgical treatment and the outcomes of critical acute pancreatitis （CAP）. Methods The clinical data of 76 patients with CAP who were treated in the Department of Biliopancreatic Surgery of the Xiangya Hospital, Central South University from January 2010 to December 2017 were retrospectively reviewed. Data which included demographics, micro-organisms, surgical interventions and mortality were compared between the time periods of 2010 to 2013 and 2014 to 2017. Results Before 2014, 19 patients with CAP were treated in the Department of Biliopancreatic Surgery of the Xiangya Hospital, Central South University. The percentage of multidrug resistant organisms （ MDRO ） in pancreatic drainage was 5.3% （1/19）. In the latter 4 years, 57 patients with CAP were treated. The percentage of MDRO was 50.9% （29/57） , which was significantly higher than the initial 4 years （P〈0.001）. For surgical treatment, the proportion of minimally invasive surgery in the latter 4 years was significantly higher than that in the initial 4 years. The percentage of peroutaneous catheter drainage （PCD） increased from 63.2% in the initial 4 years to 86.0% in the latter 4 years. The proportion of minimal access rctroperitoneal pancreatic necrosectomy （MARPN） increased from zero in the initial 4 years to 59.6%, while the proportion of open pancreatic necrosectomy （OPN） decreased from 68.4% in the initial 4 years to 24.6%. The mortality rate of patients with CAP dropped from 52.6% （10/19） in the initial 4 years to 24.6% （14/57） in the latter four years. Conclusions In the center which specializes in treating pancreatitis, although the problem of bacterial resistance had become increasingly prominent, the mortality rate of CAP had shown a significant downward trend due to the development of various minimally invasive techniques.

关 键 词：危重型急性胰腺炎 感染性胰腺坏死 微创治疗 

分 类 号：R657.51[医药卫生—外科学]