腹腔灌洗引流在重症急性胰腺炎非手术治疗中的作用——附104例随机对照研究

Efficacy of continuous peritoneal lavage for severe acute pancreatitis：a prospective randomized controlled study of 104 cases

目的探讨腹腔灌洗引流在SAP非手术治疗中的作用。方法104例SAP患者随机分为腹腔灌注组（n=45）和腹腔未灌注组（n=59）,腹腔未灌注组给予常规胃肠减压、抑酶等非手术治疗,腹腔灌注组在常规治疗基础上加腹腔灌洗引流。观察两组疗效、并发症发生率以及平均住院天数,按BalthazarCT分级标准和Ranson标准评分。结果两组治愈率和好转率比较无显著差异（P〉0.05）,但腹腔未灌注组病死率（15.3%）显著高于腹腔灌注组（P〈0.01）。死因多数由于严重并发症,如感染并发ARDS、MODS和DIC等。两组治愈病例的CT分级和Ranson分值无显著性差异,但两组好转病例CT分级均显著高于治愈病例（P〈0.01）。两组治愈或好转病例治疗后的Ranson分值均显著低于入院时（P〈0.01）。腹腔灌注组弥漫性腹膜炎、低血容量性休克、急性肾衰、Ⅱ型呼衰、ARDS和MODS的并发症发生率显著低于腹腔未灌注组（P〈0.01或P〈0.05）。腹腔灌注组治愈和好转病例平均住院天数为（21.7±10.1）d和（30.3±19.9）d,显著短于腹腔未灌注组的（35.3±16.2）d和（41.1±22.6）d（P〈0.01）。结论腹腔灌洗引流术是一种安全有效的SAP辅助治疗方法,在非手术治疗基础上行腹腔灌注的疗效明显优于单纯非手术治疗,可以减少严重并发症的发生率,降低病死率。

Objective To evaluate the role of continuous peritoneal lavage in the non-surgical management of patients with severe acute pancreatitis（SAP）.Methods A prospective study was conducted which included one hundred and four patients with SAP.The patients were randomly divided into two groups with continuous peritoneal lavage performed as the treatment group（n = 45） and traditional non-surgical therapy including gastric decompression,as the control group（n = 59）.The end-points were the scores of Balthazar CT（SBCT） and the Ranson scores.Results The cure rates and improvement rates were not significantly different between the treatment group and the control（P 〉 0.05）,but the mortality in treatment group（0.0%） was significantly lower than that in control group（15.3%,P 〈 0.01）.The deaths in control group were primarily due to serious complications,such as infection,adult respiratory distress syndrome（ARDS）,multiple organ dysfunction syndromes（MODS） and disseminated intravascular coagulation（DIC）.The SBCTs and the Ranson scores were not significantly different when compared curative patients of the treatment group with the control（P 〉 0.05）.However,the SBCTs of the patients with symptoms improved were significantly higher than those in the curative patients（P 〈 0.01）.The Ranson scores of the patients after treatment were significantly lowerthan those in the early phase of the treatment（P 〈 0.001） in the patients of the curation or improvement.In addition the incidences of complications in treatment group were significantly reduced when compared to those of control group,such as diffusive peritonitis,hypovolemic shock,acute renal failure,type II respiratory failure,ARDS,DIC and MODS（P 〈 0.01 or P 〈 0.05）.Finally,the average hospital stay（21.7 ± 10.1）d,（30.3 ± 19.9）d of treatment group was significantly shorter than that of control group（35.3 ± 16.2）d;（41.1 ± 22.6）d,P 〈 0.001） of control group.Conclusions Continuous peritoneal lavage is an effective and safe treatment option for patients with SAP.It may reduce the incidences of serious complications and mortality.