胰腺脓肿外科引流方法的选择及探讨

Choose of Drainage for Pancreatic Abscess

目的初步探讨重症急性胰腺炎后胰腺脓肿引流方法的选择指征及其疗效观察。方法收集我院近20年共58例胰腺脓肿病例,根据胰腺脓肿的大小、位置和形状分成三型,采用剖腹引流、经皮穿刺引流、低位小切口不经腹引流和F管引流四种方法。结果剖腹引流29例,其中10例需再次手术,4例经3次手术治愈,因大出血、肠瘘等并发症死亡5例;经皮肤穿刺引流10例,6例治愈,4例中转开腹后治愈;经后腰低位小切口不经腹引流12例,均获痊愈;F管治疗7例,均获痊愈。结论重症胰腺炎后胰腺脓肿引流方法的合理选择与治疗效果直接相关,脓肿分型对引流方法的选择具有指导意义。

Objective To sum up the therapeutic experience for pancreatic abscess complicated with severe acute pancretitis （SAP） and to compared the methods of drainage according to its classification , so as to guide the clinical work. Methods Altogether clinical datas of 58 patients with pancreatic abscess were collected in the latest 20 years, pancreatic abscess were divided into 3 groupes according to its size,locationa and figure. Four methods of drainage including open operation drainaging, percutaneous puncture drainaging, small incision drainaging at lower location but not into peritoneal cavity and ＂F＂ tube drainaging were adopted. Results 29 cases drainaged by open operation ,among them 10 adopted second look operation and 4 cases third look operation 5 died of the severious complications such as overwelming blooding and intestinal fistula;10 cases through percutaneous puncture drainage ,6 cases cured and the rest converting to open operation and then cured ; 12 cases by small incision through lower location but not into peritoneal cavity ,all cured. Conclusions The results sugggest the effects of drainge related directly to the choose of methods of drainage for pancreatic abscess complicated with SAP,pancreatic classification and to choose an appropriate way according the aforementioned standard will benefit clincial work.