感染性坏死胰腺组织渐进式微创路径清除术或开放手术的治疗观察

Step-up Approach or Open Necrosectomy for Necrotizing Pancreatitis

目的:感染性坏死胰腺组织渐进式微创路径清除术(微创)或开放手术的治疗效果。方法:64例患者随机化分为开放清除组和微创组,主要研究终点为并发症或死亡。结果:共有64例患者纳入研究,其中,男39例,女25例,年龄55～78(64.1±9.8)岁。开放手术组30例,男18例,女12例,年龄55～77(64.0±10.1)岁;微创组34例,男21例,女13例,年龄55～78(64.2±9.6)岁。两组患者的一般临床资料差异无统计学意义。30例开放式手术患者有22例(73.3%)达到研究终点,微创组34例患者14例(41.1%)达到研究终点,差异有统计学意义(RR=0.54,P<0.05)。微创组患者有18例(52.4%)仅施行了经皮引流术,8例(23.5%)采取了经胃引流术,10例(24.1%)进行了微创腹膜后坏死组织清除术。多器官功能衰竭发生率分别为40%、15%(P=0.009),死亡率分别为33%、18%(P=0.06)。切口疝发生率分别为25%、8%(P=0.04),糖尿病发生率分别为20%、48%(P=0.03)。结论:微侵入手术与开放性手术比较,前者能够降低坏死性胰腺炎的死亡率和并发症。

Objective：To study of Step-up approach or open necrosectomy fornecrotizing pancreatitis.Methods：64 patients were randomized divided into open debridement and minimally invasive group,the main study endpoints were the complications and death.Results：A total of 64 patients were included in the study,39 cases were male,25 female,the age were 55～78（64.1±9.8） years.Open operation group there are 30 cases,18 cases were male and 12 female,the age were 55～77（64± 10.1）;minimally invasive group 34 cases,21 were male and 13 female,the age were 55～78（64.2 ± 9.6） years.The general clinical data of patients in the two groups have no significant difference.22 cases achieved（73.3%） study endpoints in open operation patients,and 14 patients（41.1%） achieved study endpoints in minimally invasive,the difference there was statistically significant（RR = 0.54,P〈0.05）.18 cases（52.4%） of minimally invasive group of patients performed only percutaneous drainage,8 cases（23.5%） were taken by gastric drainage and 10 patients（24.1%） underwent minimally invasive retroperitoneal necrotizing tissue removal.Multiple organ failure incidence is 40%,15%（P=0.009）,mortality were 33%,18%（P=0.06）,respectively.Incisional hernia incidence were 25%,8%（P=0.04）,the incidence of diabetes mellitus were 20%,48%（P = 0.03）,respectively.Conclusion：The mortality and complication of the minimally invasive operation was lower than that of open operation.