围胰腺区域性微创治疗重症急性胰腺炎

Minimally invasive surgical treatment with per-pancreat region for sever acute pancreatitis

目的研究围胰腺区域性微创治疗重症急性胰腺炎（SAP）的临床效果。方法在维持器官功能的基础上，54例SAP患者分为两组，A组（n=28）采用微创手术，入院即行床边局部麻醉置入自制腹腔双套管于胰腺区域持续冲洗，后期对结石患者采用腔镜技术清除结石；B组（n=26）采用开腹清除胰腺坏死组织，行胆道减压、胃造瘘、空肠造瘘，并置入腹腔双套管于胰腺区域。两组术后均用0．5％氟尿嘧啶生理盐水液进行围胰腺区域持续滚动盥洗引流。结果两组患者手术后腹腔引流液从暗红色血性逐渐清亮，淀粉酶含量1周后与入院时比较均显著下降（t=2．68，P=0．013；t=2．41，P=0．028）。A组白细胞计数、体温、心率也较手术前显著改善（t=2．32，P=0．035；t=2．39，P=0．021；t=2．38，P=0．023）。A组病死率、并发症发生率、住院时间和治疗总费用显著低于B组（χ^2=8．62，P=0．001；χ^2=6．35，P=0．014；t=2．22，P=0．034；t=2．67，P=0．010），但治愈率显著高于B组（χ^2=3．89，P=0．045）。结论围胰腺区域性微创治疗SAP既能去除病因，又能充分引流、及时阻断SAP恶性病理循环。与开腹手术比较，微创美观，操作简便，并发症少，疗效显著。

Objective To investigate the clinical effect of the minimally invasive surgical treatment with per-pancreat region for sever acute pancreatitis （SAP）. Methods Fify-four cases of SAP were divided into two groups, patients of group A （n = 28 ） were given minimally invasive surgical treatments （step 1 ：under local anesthesia, patients were put the home-made double cannula in the abdominal around the region of pancreas, step 2：patients with biliary stone were performed by laparoscopical operations）. Patients of group B （ n = 26 ） were treatment by open operations including biliary decompression, gastrostomy, jejunostomy, removing necrotic pancreatic organizations and puting the double cannula around the region of pancreas. Through double cannula around the pancreas area, all patient＇s cavity were persistently douched using 0. 5% 5-FU saline solution. Results Washed after one week, two groups patient＇s drainage fluid amylase concentration were decreased significantly （t = 2. 68, P = 0.013;t = 2.41, P = 0. 028 ） , patient＇s white cell count, body temperature, heart rate of Groups A were also decreased significantly （ t = 2. 32, P = 0. 035 ; t = 2. 39,P = 0.021;t = 2. 38, P = 0.023） . Compared with group B, the mortality, the incidence of complications, hospitalization time and total cost of treatment of group A patients were significantly lower than that of group B（ χ^2 =8.62,P =0. 001 ;χ^2 =6. 35 ,P =0. 014;t =2. 22,P =0. 034;t = 2. 67,P =0. 010） ,but the cure rate was significantly higher than that of group B （ χ^2 = 3. 89,P = 0. 045）. Conclusions Minimally invasive surgical treatment of per-pancreatic region for SAP can not only remove the causes, but also fully drainage and timely block the pathological vicious cycle of SAP. What is more, it is simple, minimally invasive and have few complications and significant effect.