负压封闭引流技术治疗重症急性胰腺炎的临床研究

Treatment for severe acute pancreatitis by vacuum sealing drainage

目的探讨负压封闭引流技术(VSD)在重症急性胰腺炎(SAP)治疗中的临床应用。方法将38例SAP患者随机分为两组:观察组20例,采用负压封闭引流技术治疗,对照组18例,采用常规引流方法治疗。观察患者的手术次数,恢复进食时间,术前及术后第3天血淀粉酶、白细胞计数、血钙、血糖差值,术后并发症,术后住院天数,转归及总住院费用等。结果手术次数观察组(3.1±0.8)次,对照组(5.9±1.6)次,差异有统计学意义(P<0.001);术后进食时间观察组(3.3±1.8)d,对照组(7.2±2.2)d,差异有统计学意义(P<0.001);首次手术前与术后第3天血淀粉酶差值观察组(248.3±76.3)U,对照组(150.3±63.8)U,差异有统计学意义(P<0.05);WBC差值观察组(5.2±1.3)×109/L,对照组(3.1±1.0)×109/L,差异有统计学意义(P<0.001);血钙差值观察组(0.13±0.06)mmol/L,对照组(0.24±0.09)mmol/L,差异有统计学意义(P<0.001);血糖差值观察组(4.65±1.27)mmol/L,对照组(3.37±1.14)mmol/L,差异有统计学意义(P<0.05);住院天数观察组(15.6±2.3)d,对照组(36.3±9.4)d,差异有统计学意义(P<0.001);住院费用观察组(45268.5±2801.6)元,对照组(87588.3±5533.0)元,差异有统计学意义(P<0.001);两组并发症,治愈率及死亡率比较差异均无统计学意义。结论负压封闭引流技术治疗重症急性胰腺炎术后恢复快,可明显缩短住院时间,降低住院费用,有良好的临床推广应用价值。

【Objective】 To investigate the clinical effect and feasibility of treatment for severe acute pancreatitis（SAP） by vacuum sealing drainage（VSD）.【Methods】 Thirty-eight patients with SAP were randomly allocated into 2 groups,study group（n=20）,in which patients were treated by VSD,and control group（n =18）,in which patients were treated by normal drainage according to the traditional method.The indexes were investigated which included frequency of operation,time of food intake,post-operative hospitalization days,post-operative complications,variations of post-operative consequence of laboratory examination（including the first day and the third day changes of hemodiastase,WBC,Ca2＋,GLU）,prognosis of the diseases and total cost of hospitalization.【Results】 In control study between study group and control group,the frequency of operation was（3.1±0.8） vs（5.9±1.6）（P 0.05）,time of post-operative food intake was（3.3±1.8）d vs（7.2±2.2） d（P 0.05）.Between pre-operation and the third day afterthe first operation,the variance of hemodiastase was（248.3±76.3） u vs（150.3±63.8） u（P 0.05）,leukocyte count was（5.2±1.3）×109 /L vs（3.1±1.0）×109 /L（P 0.001）,blood calcium was（0.13±0.06） mmol/L vs（0.24±0.09） mmol（P0.001） and blood glucose was（65±1.27） mmol/L vs（3.37±1.14） mmol/L（P 0.05）.Hospital day was（15.6±2.3） d vs （36.3±9.4） d（P 0.05）,the cost of hospitalization was（45268.5±2801.6） yuan vs（87588.3±5533.0） yuan（P 0.01）.These data showed that there were significant differences between both groups.However,there was no difference between the two groups in complications,recovery rate and mortality.【Conclusions】The treatment for SAP by VSD has the advantages of good curative effect,shortening hospital day and decreasing cost of hospitalization.This suggests that the therapeutic measure has a value to manage SAP.