置管引流并胆道镜清创治疗重症急性胰腺炎继发的胰腺及胰周感染22例体会

Treatment of pancreatic and peripancreatic infections secondary to severe acute pancreatitis by ultrasound-guided puncture & catheterization and debridement under choledochoscope:an analysis of 22 cases

目的介绍并总结一种治疗重症急性胰腺炎(SAP)继发的胰腺及胰周感染的新方法。方法对2004年1月至2007年4月成都军区总医院收治的22例SAP继发的胰腺及胰周感染病人的治疗过程进行分析。在B超引导下穿刺置管引流,3～5d后拔除引流管,采用扩皮器将其窦道适当扩开后,再放置一粗引流管进行引流。1周后,拔除粗引流管,应用胆道镜在感染灶内进行清创。结果通过上述方法治疗22例病人,胰腺及胰周感染的坏死组织及积液均达到有效的引流或清创。其中,15例胰腺及胰周感染灶完全消失;4例因残余脓肿位于脾门或髂窝,胆道镜难以安全清创,于后期行开腹脓肿引流手术;3例形成胰腺假性囊肿择期施行囊肿空肠吻合。结论采用超声引导穿刺置管引流并胆道镜清创治疗SAP继发的胰腺及胰周感染,方法简单、安全,临床效果可靠。

Objective To introduce and summarize a new method in treatment of pancreatic and peripancreatic infections secondary to severe acute pancreatitis. Methods The treatments of 22 cases of pancreatic and peripancreatic infections secondary to severe acute pancreatitis admitted between 2004 and 2007 at Chengdu General Hospital of PLA Chengdu Command were analyzed. The treatment procedure included as following： puncturing and placing a catheter through B-ultrasonic guidance for drainage of pancreatic and peripancreatic infections, and then removing the catheter after 3-5 days, expanding the sinus tract of the catheter with a skin expander, and then placing a large-diameter tube for drainage, removing the large-diameter tube and debriding under a choledochoscope in the next week. Results Of all the 22 cases treated by the above method, pancreatic and peripancreatic infections were effectively drained or removed. Among them, 15 cases were relieved of pancreatic and peripancreatic infections completely. Four cases underwent open-abdominal surgery for drainage as the residual abscess was located in the hilus lienis or iliac fossa difficult to debride under choledochoscope. Three cases underwent cysto-jejunostomy due to formation of pancreatic pseudocyst. Conclusion Uhrasound-guided puncture ＆ catheterization and debridement under choledochoscope is a simply, safe and reliable treatment method for pancreatic and peripancreatic infections secondary to severe acute pancreatitis.