经皮腹膜后胰腺坏死组织视频辅助与开腹清创引流术的疗效对比  

Comparison of the Effect of Video-Assisted Drainage and Open Debridement Drainage on Percutaneous Retroperitoneal Pancreatic Necrosis

作　　者：宋盛平 张旭[1] 宗可 薛建锋[1] SONG Shengping;ZHANG Xu;ZONG Ke;XUE Jianfeng(Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院肝胆胰外科,河南郑州450000

出　　处：《河南医学研究》2024年第10期1821-1825,共5页Henan Medical Research

摘　　要：目的 对比研究经皮腹膜后胰腺坏死组织视频辅助清创引流术与开腹胰腺坏死组织清创引流术的临床疗效。方法 回顾性选取2020年4月至2022年4月收治的50例急性坏死性胰腺炎患者临床资料,依据治疗方式分为A组(28例)、B组(22例),前者行经皮腹膜后胰腺坏死组织视频辅助清创引流术,后者行开腹胰腺坏死组织清创引流术。比较两组手术指标、手术前后免疫功能[CD3^(+)、白细胞计数(WBC)、CD4^(+)]、生化指标[血钙、血清淀粉酶、血糖]、炎症应激指标[髓样分化蛋白-88(MyD88)、白细胞介素-4(IL-4)、5-羟色胺(5-HT)]、术后并发症。结果 两组清创前ICU停留例数相比,差异无统计学意义(P>0.05);与B组相比,A组住院时间、术后排气时间、手术时间较短,进食时间较早,出血量较少(P<0.05);与B组相比,A组术后7 d CD3^(+)、CD4^(+)指标较高,WBC指标较低(P<0.05);与B组相比,A组术后7 d血清淀粉酶、血糖指标较低,血钙指标较高(P<0.05);与B组相比,A组术后7 d血清MyD88、IL-4、5-HT水平较低(P<0.05);两组并发症发生率相比,差异无统计学意义(P>0.05)。结论 经皮腹膜后胰腺坏死组织视频辅助清创引流术能改善患者免疫功能,降低生化指标,减轻炎症应激反应,安全性较好。Objective To compare the clinical efficacy of percutaneous retroperitoneal video-assisted debridement and drainage of pancreatic necrotic tissue with laparotomy.Methods Clinical data of 50 patients with acute necrotizing pancreatitis treated from April 2020 to April 2022 were retrospectively selected and divided into group A(28 cases)and group B(22 cases)according to different treatment methods.The former underwent percutaneous video-assisted debridement and drainage of pancreatic necrotic tissue,while the latter underwent laparotomy and drainage of pancreatic necrotic tissue.Surgical indexes,immune function[CD3^(+),white blood cell count(WBC),CD4^(+)],biochemical indexes[blood calcium,serum amylase,blood glucose],inflammatory stress indexes[myeloid differentiation protein-88(MyD88),interleukin-4(IL-4),5-hydroxytryptamine(5-HT)]and postoperative complications were compared between the two groups.Results There was no difference in the number of ICU stays between the two groups before debridement(P>0.05).Compared with group B,group A had shorter hospital stay,postoperative exhaust time and operation time,earlier feeding time and less blood loss 7 days after operation(P<0.05).Compared with group B,CD3^(+)and CD4^(+)indexes were higher in group A,and WBC indexes were lower 7 days after operation(P<0.05).Compared with group B,the serum amylase and blood glucose indexes in group A were lower and the blood calcium indexes were higher 7 days after operation(P<0.05).Compared with group B,the levels of serum MyD88,IL-4 and 5-HT in group A were lower 7 days after operation(P<0.05).There was no difference in the incidence of complications between the two groups(P>0.05).Conclusion Video assisted debridement and drainage of retroperitoneal pancreatic necrotic tissue can improve the immune function of patients,reduce biochemical indexes,relieve inflammatory stress response,and have good safety.

关 键 词：急性坏死性胰腺炎 清创引流术 开腹术 经皮腹膜后入路 

分 类 号：R657.5[医药卫生—外科学]