小网膜囊及两侧腹膜后敞开灌洗联合区域动脉药物灌注治疗早期重症急性胰腺炎临床分析

Lesser sac and both sides of the retroperitoneal space opening iavage with regional arterial perfusionfor the treatment of early severe acute pancreatitis

目的 探讨小网膜囊、两侧腹膜后敞开灌洗联合区域动脉药物灌注治疗早期重症急性胰腺炎（SAP）患者的临床价值.方法 回顾分析2003年至2011年焦作市人民医院胰腺外科采用小网膜囊、两侧腹膜后敞开灌洗联合区域动脉药物灌注治疗26例早期SAP患者的临床资料.结果 术后第1天患者的体温、脉搏、呼吸、APACHEⅡ评分、腹腔压力、中心静脉压、血糖、WBC、PaCO2、三酰甘油、肌酐分别为（37.4±0.9）℃、（104±13）次/rain、（21 ±5）次/min、（12.3±4.0）分、（11.8±2.1）cm H2O（l cmH2O=0.098 kPa）、（18.2 ±0.6）cm H2O、（7.7±0.6） mmol/L、（9.54 ±2.80）×109/L、（42.40 ±4.72）mm Hg（l mm Hg =0.133 kPa）、（13.83±1.01） mmol/L、（215.6±3.5） μmol/L,较术前显著下降,差异均有统计学意义（P值均＜0.01）.术后第1天尿量、PaO2、平均动脉压（MAP）分别为（90.6±4.5） ml/h、（88.15 ±3.02）mm Hg、（84.8 ±3.4）mm Hg,较术前显著增加,差异有统计学意义（P值均＜0.01）.术前发生呼吸窘迫综合征22例（84.6％）,急性肾功能衰竭15例（57.6％）,休克14例（53.8％）,全身炎症反应综合征22例（84.6％）,术后分别下降至2例（7.6％）、l例（3.8％）、1例（3.8％）、3例（11.5％）.术后发生肠瘘2例（7.6％）,胰瘘3例（11.5％）,腹腔内出血2例（7.6％）,真菌感染12例（46.2％）.全组治愈率92.3％（24/26）,病死率7.7％（2/26）.结论 小网膜囊、两侧腹膜后敞开灌洗联合区域动脉药物灌注治疗早期SAP效果满意,能显著地提高患者生存率,降低病死率.

Objective To investigate the effectiveness of lesser sac and both sides of the retroperitoneal space opening lavage with regional arterial perfusion for the treatment of early severe acute pancreatitis （SAP）.Methods The clinical data of 26 cases of early SAP who underwent lesser sac and both sides of the retroperitoneal space opening lavage with regional arterial perfusion from 2003 to 2011 were retrospectively evaluated in Department of Pancreatic Surgery,Jiaozuo People＇s Hospital.Results At 1st day after operation,the body temperature,pulse,respiratory rate,APACHE Ⅱ score,abdominal pressure,central venal pressure （CVP）,blood glucose,WBC,PaCO2,triglycerides,creatinine were （37.4±0.9） ℃,（104 ± 13）/min,（21 ±5）/min,（12.3 ±4.0）,（11.8 ±2.1）cm H2O （lcm H2O =0.098 kPa）,（18.2 ±0.6） cm H2O,（7.7 ±0.6）mmol/L,（9.54±2.80） × 109/L,（42.40±4.72）mm Hg （1 mm Hg=0.133 kPa）,（13.83 ± 1.01） mmol/L,（215.6±3.5） μmol/L,which were significantly lower than those before operation,and the difference between the two groups was statistically significant （P 〈0.01）.At 1st day after operation,urine output,PaO2,mean arterial pressure （MAP） were （90.6 ± 4.5） ml/h,（88.15 ± 3.02） mmHIg,（84.8 ± 3.4） mmHg,which were significantly higher than those before operation,and the difference between the two groups was statistically significant （P〈0.01）.ARDS,acute renal failture,shock,SIRS occurred in 22 （84.6%）,15（57.6%）,14（53.8%） and 22（84.6%） cases,which were decreased to 2（7.6%）,1 （3.8%）,1 （3.8%） and 3 （11.5%） after treatment.Postoperative intestinal fistula,pancreatic fistula,intraperitoneal bleeding,fungal infection occurred in 2 （7.6%）,3 （11.5%）,2 （7.6%）,12 （46.2%） patients.The cure rate and mortality rates was 92.3% （24/26） and 7.7% （2/26） respectively.Conclusions Lesser sac and both sides of the retroperitoneal space opening lavage with regional arterial perfusion are effective for the treatment of early SAP,which can significantly improve survival and reduce mortality.