经双腔引流管大容量灌洗并持续负压引流用于感染性胰腺坏死的疗效分析  

Efficacy of large-volume lavage through a double-lumen drainage tube and continuous negative pressure drainage for infectious pancreatic necrosis

作　　者：党军强 贾亭街 张志强 龚新利 王浩瑜 任彦顺 Jun-Qiang Dang;Ting-Jie Jia;Zhi-Qiang Zhang;Xin-Li Gong;Hao-Yu Wang;Yan-Shun Ren(Department of Hepatobiliary,Pancreatic and Splenic Surgery,People’s Hospital of Tongchuan,Tongchuan 727031,Shaanxi Province,China;Department of General Surgery,Hospital of Lanzhou University,Lanzhou 730000,Gansu Province,China)

机构地区：[1]铜川市人民医院肝胆胰脾外科,陕西省铜川市727031 [2]兰州大学校医院普通外科,甘肃省兰州市730000

出　　处：《世界华人消化杂志》2021年第1期21-28,共8页World Chinese Journal of Digestology

摘　　要：背景感染性胰腺坏死临床多采用手术治疗.然而,术后残余组织的引流仍存在引流不充分,引流管易堵塞等问题.本研究拟采取胰周双腔引流管大容量灌洗并持续负压引流的方法,并与同期采用普通引流的患者相比较.目的探讨胰周双腔引流管大容量灌洗并持续负压引流用于感染性胰腺坏死(infected pancreatic necrosis,IPN)的临床疗效.方法回顾性分析铜川市人民医院肝胆胰脾外科2015-06/2019-06收治的57例行手术治疗的感染性胰腺坏死患者的临床资料.按照术后冲洗引流方式不同,分为双腔引流管组和普通引流管组.双腔引流管组患者术中放置胰周双腔引流管并在术后行大容量灌洗并持续负压引流;普通引流管组患者术中放置小网膜囊引流管并术后行常规冲洗和引流.观察并比较两组患者治疗效果及引流情况.结果两组在人口统计学数据、胰腺炎的病因和疾病严重程度、手术时间、术中失血量、重症护理时间方面无明显差异.两组术后持续器官衰竭逆转数(84.21%vs 56.25%,P=0.13),严重并发症发生率(16.67%vs 33.33%,P=0.14)无明显差异;总体死亡率为12.28%.尽管无显著的统计学差异(P=0.17),但普通引流管组患者死亡率更高.双腔引流管组APACHEⅡ评分减少幅度更大(8.03±2.13 vs 3.85±1.29,P<0.01),无再手术病例(0 vs 22.22%,P=0.008),住院时间更短,引流管更通畅,能够更早的拔除引流管(P<0.01).结论经双腔引流管大容量灌洗并持持续负压引流是IPN的有效引流方法,可有效治疗IPN.BACKGROUND Infectious pancreatic necrosis(IPN)is usually treated by surgery.However,the drainage of residual tissues still has problems such as insufficient drainage and easy blockage of the drainage tube.In this study,we compared the efficacy of large-volume lavage through a peripancreatic double-lumen drainage tube and continuous negative pressure drainage vs conventional drainage for IPN.AIM To evaluate the clinical efficacy of large-volume lavage through a peripancreatic double-lumen drainage tube and continuous negative pressure drainage for IPN after operation.METHODS The clinical data of 57 cases of IPN who received surgical treatment at the Department of Hepatobiliary,Pancreatic and Splenic Surgery,People’s Hospital of Tongchuan from June 2015 to June 2019 were retrospectively analyzed.According to the method of postoperative drainage used,the patients were divided into either a double-lumen drainage tube group or a conventional drainage tube group.RESULTS The two groups had no significant differences in demographic data,etiology and severity of pancreatitis,operation time,intraoperative blood loss,and duration of intensive care unit stay.There were also no significant differences between the two groups in the number of reversals of postoperative continuous organ failure(84.21%vs 56.25%,P=0.13)and the incidence of serious complications(16.67%vs 33.33%,P=0.14).The overall mortality rate was 12.28%.The mortality rate was higher in the conventional drainage tube group,but there was no statistically significant difference between the two groups(P=0.17).Compared to the conventional drainage tube group,the double-lumen drainage tube group had significantly reduced APACHEⅡscore(8.03±2.13 vs 3.85±1.29,P<0.01)and reoperation cases(0 vs 22.22%,P=0.008),shorter hospitalization,more unobstructed drainage tubes,and earlier removal of drainage tubes(P<0.01).CONCLUSION Large volume lavage through a double-lumen drainage tube and continuous negative pressure drainage is an effective method for IPN,which can be used

关 键 词：急性胰腺炎 感染性胰腺坏死 灌洗术 负压引流 

分 类 号：R657.5[医药卫生—外科学]