超声引导经皮腹膜后穿刺置管引流前腹腔穿刺引流治疗重症急性胰腺炎  

Abdominal paracentesis drainage before ultrasound-guided percutaneous retroperitoneal catheter drainage for severe acute pancreatitis

作　　者：李盈 刘明辉[1] 王国涛[1] 陈钦奇 刘洁玉[1] 赵白桦[1] LI Ying;LIU Minghui;WANG Guotao;CHEN Qinqi;LIU Jieyu;ZHAO Baihua(Department of Ultrasound,the Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院超声科,湖南长沙410011

出　　处：《中国介入影像与治疗学》2018年第11期670-673,共4页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的探讨超声引导经皮腹膜后穿刺置管引流(PRCD)前先行腹腔穿刺引流(APD)对重症急性胰腺炎的临床价值。方法回顾性分析88例重症急性胰腺炎的临床资料。根据治疗方式将患者分为APD+PRCD组(n=46)及单纯PRCD组(n=42)。对2组患者术后死亡情况、并发器官衰竭和感染及恢复情况、医疗成本进行比较。结果与单纯PRCD组相比,APD+PRCD组患者术后死亡率[2.17%(1/46)vs 14.29%(6/42);χ2=4.40,P=0.04]、并发器官衰竭发生率[76.09%(35/46)vs 88.10%(37/42);χ2=6.34,P=0.01]均明显降低,器官衰竭持续时间[(15.52±2.53)天vs(17.67±2.06)天;t=4.34,P<0.01]、住院治疗时间[(47.93±9.27)天vs(52.62±8.32)天;t=2.49,P=0.02]、治疗期间入住重症监护室时间[(7.39±2.13)天vs(8.76±2.57)天,t=2.73,P=0.01]均明显缩短,治疗费用[(46 541.93±8 326.67)元vs(52 518.43±8 874.60)元;t=3.26,P<0.01]明显减少。2组患者并发感染情况(单一病原微生物感染、多种病原微生物感染、无感染)差异无统计学意义(χ~2=0.28,P=0.87)。APD+PRCD组术后外周血白细胞水平恢复正常所需时间明显短于单纯PRCD组[(21.32±1.89)天vs(26.13±2.10)天;t=11.34,P<0.01]。结论超声引导PRCD前APD可有效降低重症急性胰腺炎患者的死亡率及器官衰竭率,缩短器官衰竭持续时间和住院时间,节约治疗费用,且不增加感染风险。Objective To investigate the clinical value of abdominal paracentesis drainage(APD)before ultrasound-guided percutaneous retroperitoneal catheter drainage(PRCD)for treatment of severe acute pancreatitis(SAP).Methods Clinical data of 88 patients with SAP were retrospectively analyzed.The patients were divided into APD+PRCD(n=46)or simple PRCD group(n=42)according to the treatment method.The postoperative mortality,concomitant organ failure,infection and recovery,as well as the medical costs were compared between the two groups.Results Compared with simple PRCD group,the postoperative mortality(2.17%[1/46]vs 14.29%[6/42];χ2=4.40,P=0.04)and the frequency of organ failure(76.09%[35/46]vs 88.10%[37/42];χ2=6.34,P=0.01)significantly reduced in PRCD+APD group,while the duration of organ failure([15.52±2.53]days vs[17.67±2.06]days;t=4.34,P<0.01),hospitalization time([47.93±9.27]days vs[52.62±8.32]days;t=2.49,P=0.02)and intensive care unit curative time([7.39±2.13]days vs[8.76±2.57]days;t=2.73,P=0.01)were significantly shortened in PRCD+APD group.The treatment expense([46 541.93±8 326.67]Yuan vs[52 518.43±8 874.60]Yuan;t=3.26,P<0.01]of PRCD+APD group decreased significantly than that of simple PRCD group.There was no statistical difference in the infection status(single pathogenic microorganism infection,multiple pathogenic microorganism infection and no infection)between the two groups(χ2=0.28,P=0.87).The time required to recover the normal level of peripheral blood leucocyte of APD+PRCD group was significantly shorter than that of simple PRCD group([21.32±1.89]days vs[26.13±2.10]days;t=11.34,P<0.01).Conclusion APD before ultrasound-guided PRCD could not only decrease the mortality and the organ failure rate,shorten the duration of organ failure,but also reduce hospitalization time and save treatment costs without increase the risk of infection.

关 键 词：胰腺炎 穿刺术 超声检查 影像引导 

分 类 号：R576[医药卫生—消化系统] R815[医药卫生—内科学]