腹腔镜手术治疗急性重症胰腺炎腹内高压疗效分析

Analysis on curative effect of intra-abdominal hypertension in patients with severe acute panerealitis treated by laparoseopic surgery

目的本文拟对SAP患者经膀胱间接监测IAH和早期应用腹腔镜技术治疗SAP和[AH重要性进行探讨。方法对我院12年来收治的201例SAP患者，进行了常规IAP测定，IAP〉25mmHg60例。按单双号将患者分为两组，A组30例进行腹腔镜下灌洗、引流、清除坏死组织手术，B组30例给予禁食、胃肠减压、抗感染、生长抑素等综合治疗待腹腔脓肿形成后再进行剖腹手术。结果两组病死率分别为16．7％、23．3％，并发AODS率为10．O％、20．0％。A组腹内高压持续时间和住院时间较B组明显缩短（P〈0．05），腹腔感染发生率明显降低（P〈0．05），血性感染发生率和死亡率也有所减少fP〈0．05）。结论SAP诊断成立IAP升高〉25mmHg以上，应尽早在腹腔镜下经腹膜外径路进行腹腔灌洗、引流、清除坏死组织。

Objective To explore the importance of monitoring intra-abdominal hypertension （IAH） through bladder and early application of laparoscopic techniques for the patients with severe acute pancreatitis （SAP）. Methods Data of intra-abdominal pressure （IAP） from 201 SAP patients hospitalized in the past 12 years was observed and 60 cases （IAP〉25 mmHg）were included. According to the order of admission, patients were randomly divided into singular group （observation） and dual groups （control） （~30）. Group A was treated by laparoscopic irrigation, drainage and removing necrotic tissue, while the group B was given traditional compre- hensive treatment including dual fast, gastrointestinal decompression, resistance to infection, somatostatin and laparotomy in case of abdominal abscess formation. Results Case fatality rate in the two groups were 16.7% and 23.3% respectively and concurrent arterial occlusive diseases （AODs） rate we~ 10.0% and 20.0%. For the com- plications and prognosis, IAH duration and hospitalization time in group A were significantly shortened （P〈O.05） while abdominal cavity infection rate was decreased obviously （P〈O.05） compared with those of group B. Hemor- rhagic infection incidence and mortality rate in group A were also reduced （P〈0.05）. Conclusion Once SAP di- agnosis established （IAP〉25mmHg）, early treatment by laparoscopic irrigation, drainage and removing necrotic tissue via peritoneal outside diameter should be conducted.