后腹腔镜技术在一例重症急性胰腺炎外科治疗中的应用

Retroperitoneoscopic necrosectomy in management of severe acute pancreatitis for one case

目的介绍后腹腔镜下坏死组织清除及置管引流术治疗重症急性胰腺炎(SAP)的临床经验。方法 SAP患者1例,男,26岁,术前病程4周余。参考后腹腔镜肾上腺手术方法选取体位、建立腹膜后操作空间、布置Trocar,经腹膜后行胰腺坏死组织清除、置管引流术。结果患者共行2次手术(双侧),手术时间分别为60min、45min,术中出血量均为20ml,术后留置3根腹腔引流管。患者术后疼痛轻,恢复顺利,2次手术后住院48d。右侧术中损伤后腹膜,左侧术后并发腹膜后感染,均经保守治疗后痊愈。结论对于SAP患者来说,后腹腔镜下坏死组织清除、置管引流术是安全、可行的。该术式具有入路直接、操作简便、坏死组织清除彻底、不入腹腔、手术创伤小等优点。

Objective To evaluate the feasibility of retroperitoneoscopic necrosectomy in management of severe acute pancreatitis （SAP）. Methods A 26-year-old male with SAP was enrolled. According to retroperitoneoscopic adrenal surgery, the patient position, retroperitoneoscopic space and trocar position were created first, then necrosectomy and drainage were performed under retroperitoneal space. Results The patient has accepted 2 cases of Retroperitoneoscopic necrosectomy, left and right. Operative time was 60 min and 45 rain respectively, and blood loss was 20 ml both. Postoperative recovery was fast, length of stay was 48 clays after 2nd operation. Retroperitoneal infection was occurred after 1st operation, which was cured conservatively. Conclusions For selected SAP patient, Retroperitoneoscopic necrosectomy is safe, and feasible, which has some potential advantages, such as direct surgical approach, simplified manipulation, minor complication and fast recovery.