急性坏死性胰腺炎的介入治疗

Interventional therapy of acute necrotizing pancreatitis

目的评价经动脉插管灌注５Ｆｕ（５氟尿嘧啶）和抗生素治疗急性坏死性胰腺炎的疗效。方法２３例急性坏死性胰腺炎患者，根据ＣＴ检查结果置导管于病变部位的供血动脉。２１例置管于腹腔动脉，１例于脾动脉，１例于胃十二指肠动脉。经导管２４小时持续灌注５Ｆｕ和抗生素６～２０天。结果２３例中２０例经局部动脉药物灌注，病情得到缓解，２例药物灌注后行腹腔脓肿和假性囊肿感染手术引流，１例置管后尚未给药，病情即迅速恶化，死于多脏器衰竭。结论经腹腔动脉插管药物灌注治疗急性坏死性胰腺炎疗效肯定，并发症少，死亡率低，可改善患者的身体状况，即使发生胰腺感染，也有利于后期手术。

Purpose To evaluate the intra arterial infusion of pancreatic enzyme inhibitor and antibiotics in the treatment of acute necrotizing pancreatitis(ANP). Methods 23 patients with ANP were treated by arterial infusion, by placing a catheter in the celiac artery, spleen artery or gastroduodenal artery. 5 Fu and antibiotics was used continuously for 6 to 20 days. According to the site of the inflammation on the CT scan, the top of the catheter was positioned in the celiac artery in 21 cases, splenic artery in one, and gastrodoudenal artery in one. Results The mortality rate in this study was 0% and no procedure related complication was observed. 20 of 23 patients had good effect without severe complications. In 2 cases, drainage of parapancreatic abscess was performed after improvement of the acute inflammation with the arterial infusion antibiotics, one patient died of multi organ failure before arterial infusion was started. Conclusion Arterial infusion therapy of 5 Fu and antibiotics for ANP offers good therapeutic effect and creates the possibility for subsequent operation on abscess.