腹腔镜下置管灌洗引流在重症急性胰腺炎早期治疗中的应用

Laparoscopic peritoneal lavage and drainage in early treatment of severe acute pancreatitis

目的探讨腹腔镜下置管灌洗引流(LPLD)在重症急性胰腺炎(SAP)早期治疗中应用的可行性、临床价值与技术特点。方法用LPLD的方法早期治疗21例SAP病人,对治疗结果进行回顾性分析。结果LPLD手术时间(654±276)min,术后灌洗引流时间(113±86)d,术后住院时间(325±146)d。LPLD同期完成腹腔镜胆囊切除术5例,腹腔镜经胆囊管胆总管取石1例,胆总管切开取石、T管引流术2例。1例术后4d死于多脏器功能障碍综合征(MODS),余20例治愈出院。术后随访2～22个月,发现假性胰腺囊肿1例,行内引流手术治愈。结论LPLD是SAP早期治疗中一种安全可行的方法,它用微创的方法达到开腹手术全面探查、充分灌洗引流治疗SAP的目的,值得临床推广应用。

Objective To determine the feasibility, clinical value and technical features of laparoscopic peritoneal lavaged and drainage (LPLD) in the early treatment of severe acute pancreatitis (SAP). Methods The clinical data of 21 patients with SAP treated in the early stage by LPLD in our hospital were retrospectively analyzed. Results The duration of LPLD was 65.4±27.6 min. The time for lavaged and drainage after LPLD was 11.3±8.6 d. The duration of hospitalization was 32.5±14.6 d. During LPLD, laparoscopic cholecystectomy was performed in 5 patients, laparoscopic common biliary duct lithotomy through cystic duct in 1, laparoscopic common biliary duct exploration, lithotomy and T tube biliary drainage in 2. All the 21 patients but 1 who died of multiple organ dysfunction 4 d after LPLD were cured and discharged from hospital. The 20 surviving patients were followed up for 2-22 months. It was found that 1 patient had pancreatic pseudocyst and he was cured by internal drainage of pseudocystic-jejunostomy. Conclusions LPLD is feasible and safe for the early treatment of SAP. It can achieve the same results of complete exploration, sufficient peritoneal lavaged and drainage by laparotomy in a minimally invasive way. Thus LPLD is worthy of popularization in clinical practice.