胰周坏死感染外引流术后的胆道镜下清创术

Choledocoscopy assisted debridement for peripancreatic necrotizing infection residented after surgical drainage

目的总结内镜微创技术对胰周坏死感染外引流术后残余病灶清创的疗效，探讨其临床应用价值。方法收集71例胰周坏死感染经外引流术后未愈患者，采用胆道镜经引流窦道进入病灶内部直视下识别并清除坏死组织的方法进行治疗。结果经胆道镜下清创术治愈64例，治愈率90．1％，3例因经费原因中途退出治疗，4例患者分别在胆道镜下清创1～3次后因技术原因改行剖腹手术。64例胆道镜辅助清创治愈者接受胆道镜下清创2～9次，平均5．1次，87．5％的患者需4～6次清创；第一次镜下清创至治愈拔管时间为18～125d，平均71．3d。胆道镜下清创并发出血3例，肠瘘2例，均经非手术治愈。结论通过已建立的引流通道对胰周坏死感染残余病灶行胆道镜下清创术是安全、有效的微创术，值得在临床推广应用。

Objective To investigate the experience of endoscopic mini-invasive therapy for residual lesions of peripancreatic necrotizing infection with choledocoscopy-assisted debridement technique, and to explore its clinical application value. Methods 71 patients with postoperative surgical drainage and accompanied with residual focus were collected. Choledochoscope was inserted via the drainage sinus, and the focus was observed and necrotic tissue was removed under direct choledochoscopic vision. Results Of the 71 patients who underwent this procedure, 64 were cured （ success rate, 90.1% ） ; 3 patients withdraw from treatment due to economic reasons ; 4 patients received open surgery after 1 - 3 times of choledocoscopy-assisted debridement. The 64 cured patients received 2 - 9 times of choledocoscopy-assisted debridement with a mean of 5.1 times. 87.5% patients needed 4 - 6 times of procedures. The healing time was 18 - 125 days （ average 71.3 days）. Hemorrhage occurred in 3 patients and digestive tract fistula oceun＇ed in 2 patients and were resolved with non-operative management. Conclusions With the help of postoperative established surgical drainage channel, choledochoscopy-assisted debridement could be considered as a safe and effective mini- invasive treatment for residual focus of peripancreatic necrotizing infection, and is worth of clinical application.