剖腹引流术治疗重症急性胰腺炎包裹性坏死病灶的临床分析  

Clinical analysis of open surgical drainage approach in treating severe acute pancreatitis with walled-off pancreatic necrosis

作　　者：耿诚[1] 冉东辉 娄子彦 杜露[1] 晏冬[1] 王喜艳[1] 徐新建[1] Geng Cheng;Ran Donghui;Lou Ziyan;Du Lu;Yan Dong;Wang Xiyan;Xu Xinjian(Department of Pancreatic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China)

机构地区：[1]新疆医科大学第一附属医院胰腺外科,乌鲁木齐830054

出　　处：《中华胰腺病杂志》2019年第4期256-260,共5页Chinese Journal of Pancreatology

摘　　要：目的探讨剖腹引流术治疗重症急性胰腺炎包裹性坏死病灶(WOPN)的效果。方法回顾性分析2005年1月至2016年10月新疆医科大学第一附属医院收治的154例WOPN患者的临床资料,其中2005年1月至2012年10月收治的83例患者采用传统剖腹清创灌洗术(清创组),2012年11月至2016年10月收治的71例患者采用腹部小切口入路低位置管引流术(引流组),分析并比较两种方法的临床疗效。结果清创组43例(51.8%)发生术后腹腔再感染,引流组仅13例(18.3%);清创组18例(21.7%)发生手术相关消化道瘘,引流组仅4例(5.6%),两组差异有统计学意义(χ2=18.55,P=0.001;χ2=11.35,P=0.002)。清创组死亡15例(18.1%),引流组仅2例(2.8%),引流组术后病死率显著低于清创组,差异有统计学意义(χ2=9.07,P=0.003)。清创组术后直接治愈62例(74.7%),引流组为55例(77.5%),两组差异无统计学意义,但清创组3例(3.6%)带管后期以小肠瘘的转归方式治愈,而引流组有12例(16.9%),引流组显著高于清创组,差异有统计学意义(χ2=5.989,P=0.014)。结论与剖腹清创灌洗术比较,剖腹引流术治疗WOPN术后腹腔感染率、消化道瘘发生率及病死率均显著下降,是治疗WOPN的好方法。Objective To investigate the effect of open surgical drainage approach for the treatment of walled-off pancreatic necrosis (WOPN) in severe acute pancreatitis. Methods Clinical data of 154 WOPN patients admitted in the First Affiliated Hospital of Xinjiang Medical University from January 2005 to October 2016 were retrospectively analyzed. Traditional open debridement necrosectomy was performed in 83 patients from January 2005 to October 2012 (debridement group), and small abdominal incision with low-position open surgical drainage was performed in 71 patients from October 2012 to October 2016 (drainage group). The clinical outcomes of two groups were analyzed and compared. Results 43 cases (51.8%) in debridement group had postoperative intraperitoneal reinfection, while there were only 13 cases with postoperative intraperitoneal reinfection (18.3%) in drainage group;18 cases (21.7%) in debridement group had surgery-related digestive tract fistula, while there were only 4 cases with surgery-related digestive tract fistula (5.6%) in drainage group;the differences were statistically significant (χ2=18.55, P=0.001;χ2=11.35, P=0.002). 15 patients (18.1%) in debridement group and only 2 patients (2.8%) in drainage group died. The mortality in drainage group were obviously lower than that in debridement group, and the difference was statistically significant(χ2=9.07, P<0.05). 62 cases (74.7%) in debridement group and 55 cases (77.5%) in drainage group were cured directly, respectively. No significant difference was found between two groups. However, 3 cases (3.6%) in debridement group and 12 cases (16.9%) in drainage group were cured by the way of small intestinal fistula in the late stage of intubation, and the latter was higher than the former with statistically significant(χ2=5.989, P=0.014). Conclusions Compared with open debridement necrosectomy, the abdominal infection rate, digestive tract fistula rate and mortality of open surgical drainage were all significantly reduced , which may be a better treatment for

关 键 词：胰腺炎 急性坏死性 包裹性坏死病灶 感染 引流术 清创术 

分 类 号：R657.51[医药卫生—外科学]