超声引导经皮置管引流治疗急性胰腺炎早期急性液体积聚疗效分析

Efficacy of Ultrasound-guided Percutaneous Catheter Drainage for Acute Fluid Collections at Early Stage of Acute Pancreatitis

背景:急性胰腺炎(AP)病程早期可发生急性液体积聚,积液可继发感染或形成假性囊肿。目的:评价超声引导经皮置管引流(PCD)治疗AP早期急性液体积聚的疗效和安全性。方法:2001年9月～2011年3月泰州市人民医院103例重症急性胰腺炎(SAP)伴早期胰腺、胰周急性液体积聚的住院患者纳入研究,其中42例接受保守治疗,61例在保守治疗的基础上于入院48 h内接受超声引导PCD治疗。回顾性分析两组患者的治疗效果和并发症发生情况。结果:PCD治疗组体温和血清CRP水平恢复正常时间、积液消失时间、住院天数显著短于保守治疗组(P<0.05),多器官功能衰竭、败血症、假性囊肿发生率以及手术率和死亡率显著低于保守治疗组(P<0.05):置管和引流过程中无一例患者发生内脏损伤,局部皮肤无严重感染,拔管后无瘘管形成。结论:超声引导PCD治疗胰腺、胰周积液简单、有效、安全,可作为AP早期急性液体积聚的首选治疗方法。

Background：Acute fluid collections are local complication occurring early in acute pancreatitis（AP）,which may cause secondary infection and formation of pseudocyst.Aims：To assess the efficacy and safety of ultrasound-guided percutaneous catheter drainage（PCD） for acute fluid collections at early stage of AP.Methods：A total of 103 severe acute pancreatitis（SAP） patients with early pancreatic or peripancreatic acute fluid collections admitted from Sep.2001 to Mar.2011 at the Taizhou People＇s Hospital were enrolled in this study.Of them 42 patients received conservative therapy and 61 patients received conservative therapy combined with ultrasound-guided PCD within 48 hours after admission.The therapeutic efficacies and complications of the two groups were analyzed retrospectively.Results：Normalization of body temperature and serum CRP,disappearance of fluid collections and duration of hospitalization were faster or shorter（P 0.05）,and frequencies of multiple organ failure,sepsis and pseudocyst were less（P0.05） in PCD group than in conservative therapy group.Surgical operation rate and mortality were lower in PCD group than in conservative therapy group（P0.05）. No visceral injury and severe skin infection occurred during PCD procedure and no fistula was seen after extubation. Conclusions：As a simple,effective and safety treatment modality,ultrasound-guided PCD can be used primarily for pancreatic and peripancreatic acute fluid collections at early stage of AP.