腹膜后入路肾镜下感染性坏死性胰腺炎的治疗方法的改进与效果

Improvement and effect of retroperitoneoscopic Shou-wang, WANG Peng-fei, LIU Zhi wei, necrosectomy for infected neerotizing pancreatitis

目的探索充气式腹膜后人路肾镜下治疗感染性坏死性胰腺炎的疗效。方法详述采用充气式腹膜后人路肾镜对治疗感染性坏死性胰腺炎技术方法的改进，并对2009年9月至2011年12月收治的24例接受该微创手术的效果进行回顾性分析。结果24例经该法治疗的患者全部存活，术后平均住院时间29d（7～105d），其中14例只接受了一次手术治疗，7例接受了2次，3例接受了3次。有3例患者由于脓腔分隔、腹腔内存在无法通过腹膜后的方式与脓腔建立通道的残存感染灶而补充开腹手术获得治愈。结论充气式腹膜后人路肾镜下治疗感染性坏死性胰腺炎能提高治疗效果、减少并发症，可作为治疗大多数感染性坏死性胰腺炎的首选方法。

Objectives To evaluate the results and efficacy of gas-insufflated retroperitoneo- scopic necrosectomy （GIRN） for proven infected necrotizing pancreatitis （INP）. Methods 24 patients presenting proven infected pancreatic necrosis during course of acute pancreatitis were prospectively offered minimally invasive necrosectomy. A descriptive explanation of the GIRN was given together with the results of a retrospective analysis of all patients. Results All 24 patients who underwent retro- peritoneoscopic necrosectomies survived. Postoperative hospital stay ranged from 7 to 105 d （median, 29 d）. In 14 patients, GIRN yielded excellent results and avoided complementary treatment after a single ses- sion. 7 patients underwent only one repeated session and the other 3 patients underwent 3 times. 3 pa- tients finally underwent laparotomy and necrosectomy due to remaining infected necroses in the perito- neal cavity. Conclusion GIRN has been found safe and is associated with a high success rate in our limited number of patients, and it should be regarded as a first-choice surgical option for INP.