重症急性胰腺炎病程后期残余脓肿的微创治疗

Minimally invasive therapy of residual abscess in the late stage of serious acute pancreatitis

目的观察微创治疗重症急性胰腺炎病程后期残余脓肿的效果。方法选取16例重症急性胰腺炎病程后期发生残余脓肿的患者,首先在B超引导下行经皮穿刺置管引流,3～5d后拔除引流管,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。再经1周后拔除粗引流管,用胆道镜深入感染灶内进行清创。观察并记录患者治疗前后的体温、血象等变化情况。结果全部患者腹膜后和(或)腹腔内残余脓肿均得到有效治疗。随着对脓肿的充分引流及胆道镜反复清创,患者体温及血象逐渐降至正常,动态CT或B超检查显示脓肿范围逐渐缩小直至完全消失。全部患者均痊愈出院。结论采用超声引导穿刺置管引流结合胆道镜清创治疗重症急性胰腺炎病程后期的残余脓肿,方法简单,临床效果可靠。

Objective To evaluate the curative effect of minimally invasive therapy on residual abscess in the late stage of serious acute pancreatitis. Methods From Dec. 2000 to Dec. 2007, 16 patients with residual abscess （10 males and 6 females, age ranged from 35 to 58 with median of 42. 3±12. 6 years） were treated in the late stage of severe acute pancreatitis. The procedures performed on all the patients were as follows： a catheter was placed into the abscess for drainage under the guidance of ultrasonography through a puncture through abdominal wall and it was removed in 3-5 days. The remaining tract was then properly distended with a skin-expander, and a drainage tube with larger caliber was placed for further drainage. The latter was removed one week later, and debridement of the infection focus was then performed under the guidance of a choledochoscope. The body temperature and hemogram of the patients were observed and recorded before and after the treatment. Results The retroperitoneal and/or intraperitoneal residual abscesses of all the patients were treated effectively with the method mentioned above. With proper drainage and repeated debridement, patients＇ body temperature and blood cell counts were lowered gradually to normal. It was shown by dynamic CT or B-ultrasonography that the size of the abscess was gradually reduced, and then it disappeared completely. All the patients were cured and discharged from the hospital. Conclusion It is simple and safe, with reliable clinical effects, to treat residual abscess in the late stage of severe acute pancreatitis by drainage under the guidance of ultrasonography in combination with debridement through choledochoscope.