三腔连续负压引流管在感染性坏死性胰腺炎外科治疗中的临床疗效  

Clinical efficacy of triple lumen continuous negative pressure irrigation catheter in surgical management of infected necrotizing pancreatitis

作　　者：Muhammad Salman Azhar 孙吉春[1] 聂晚频[1] 李志强[1] 朱红伟[1] 刘云飞 余枭[1] 李霞[1] Muhammad Salman Azhar;SUN Jichun;NIE Wanpin;LI Zhiqiang;ZHU Hongwei;LIU Yunfei;YU Xiao;LI Xia(Department of Hepatobiliary and Pancreatic SurgeryⅡ,The Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院肝胆胰外科Ⅱ,湖南长沙410013

出　　处：《邵阳学院学报（自然科学版）》2020年第5期18-25,共8页Journal of Shaoyang University：Natural Science Edition

基　　金：湖南省科技创新计划项目(2017SK50129)。

摘　　要：目的急性胰腺炎(acute pancreatitis,AP)是一种发病率和病死率均较高的炎症性疾病,部分AP患者会演变为重症急性胰腺炎(severe acute pancreatitis,SAP)。SAP病程后期常伴有感染性胰腺坏死,这类患者病死率极高。感染性坏死性胰腺炎(infected necrotizing pancreatitis,INP)是接受外科治疗的重要指征之一,外科医师对INP干预时机、策略及方式的掌控尤为重要,本研究的目的是探讨三腔连续负压引流这一新技术对于INP患者外科治疗能否带来更好的疗效。方法回顾性分析2009年1月至2019年12月在我院通过增强CT或细针穿刺活检被诊断为INP的60例患者,这些患者均经过14 d标准化的保守治疗但病情未能明显改善。其中30例患者通过植入三腔连续负压引流管接受了外科减压治疗,而另外30例患者延续保守治疗。通过软件分析60例患者的临床资料及其他能够预示临床疗效的指标。结果三腔连续负压引流管的外科减压手术组,患者的病死率显著降低,30例患者中8例死亡(26.7%);保守治疗组出现11例死亡(36.7%),两组患者病死率具有统计学差异(P<0.05)。此外,外科减压组患者的其他病理生理指标,包括腹内压、呼吸功能、肾功能等,较保守治疗组也有显著改善。结论急性INP患者在接受保守治疗14 d后,可以使用三腔连续负压引流管的减压手术,该手术在减少病死率和改善病理生理指标方面具有显著疗效。Objectives Acute pancreatitis is an inflammatory disease with high morbidity and mortality.Some patients with acute pancreatitis(AP)will develop into severe acute pancreatitis(SAP).The late course of SAP is often accompanied by infectious pancreatic necrosis,and the mortality rate of such patients is very high.Infected necrotizing pancreatitis(INP)is one of the important indications for surgical treatment,and it is particularly important for surgeons to control the timing,strategies,and modes of INP intervention.The purpose of this study is to explore whether the new technique of triple lumen continuous negative pressure irrigation catheter can bring better efficacy in surgical treatment of INP patients.Methods A retrospective analysis of 60 patients who have undergone 14 days of standardized conservative treatment but their condition has not improved significantly and diagnosed with INP by enhanced CT or fine needle aspiration biopsy in our hospital from January 2009 to December 2019 were retrospectively analyzed.Thirty patients received surgical decompression with triple lumen continuous negative pressure irrigation catheter while the remaining 30 patients continued conservative treatment.The clinical data of 60 patients and other indicators that can predict clinical efficacy were analyzed by software for comparative analysis,including mortality and other pathophy siological data.Results In the group of surgical decompression with triple lumen continuous negative pressure irrigation catheter,the mortality rate of the patients was significantly reduced,and only 8 of the 30 patients died(26.7%).In contrast,11 deaths(36.7%)occurred in the conservative treatment group,and the mortality rate of the two groups was statistically different(P<0.05),In addition,other physiological indicators,including intrapulmonary pressure,respiratory,and renal functions,were significantly improved after decompression surgery with triple lumen continuous negative pressure irrigation catheter.Conclusion AP patients with infected necrosi

关 键 词：重症急性胰腺炎 感染性坏死性胰腺炎 腹腔减压术 多器官功能衰竭综合征 

分 类 号：R657.51[医药卫生—外科学]