腹腔置管引流后联合胆道镜治疗胰周感染的临床研究

Clinical research of the treatment in peripancreatic infection by catheterization combined with choledochoscopy

目的探讨超声引导下腹腔置管或开腹手术置管后联合胆道镜治疗胰周感染的临床价值。方法回顾性分析2006年1月～2011年12月我院收治的35例急性感染性坏死性胰腺炎患者的病例资料。对所有患者实施超声引导下经皮穿刺置管或开腹置管引流术,置管后联合胆道镜对胰周感染灶进行反复冲洗及清除。结果 35例患者中,25例通过超声引导下经皮置管成功,9例因胃肠道胀气超声无法准确定位致穿刺失败,1例穿刺导致出血,置管成功率为71.4%(25/35),10例行外科手术引流,引流时间12～110 d,平均46 d;术后患者均应用胆道镜反复冲洗及清除胰周坏死组织,1例患者死于多脏器功能衰竭。结论选择适当的患者行超声引导下腹腔置管引流治疗胰周感染方法可行,置管后联合应用胆道镜治疗胰周感染是一种安全、有效、微创的治疗方法,可以避免多次外科手术引流。

Objective To investigate the treatment of peripancreatic infection and the clinical value of ultrasound guided or the surgery catheterization combined with eholedochoseopy. Methods 35 cases of acute infective neerotizing pancreatitis were analyzed from January 2006 to December 2011 in our hospital. All patients were treated with ultrasound guided or the surgical catheterization, the necrotic tissue and pus were washed and cleaned repeatedly after the catheterization with choledoehoscopy. Results 25 eases were treated with ultrasound guided catheterization successfully, 9 cases were failed be- cause of the gastrointestinal flatulence and 1 case was failed due to the hemorrhage, the successful rate of catheterization was 71.4% （25/35）; 10 cases were treated with surgical catheterization, drainage time were 12-110 d, the mean time were 415 d, all the patients were received the washing and removal of peripancreatic nerotic tissue, 1 case was found die of mul- tiple organ failure. Conclusion Ultrasound guided catheterization in the treatment of peripancreatic infection is a safe, effective and minimally invasive method, it can also avoid repeated surgical catheterization drainage.