急性重症胰腺炎伴发胰腺脓肿或胰腺感染坏死的诊疗分析

Diagnosis and treatment principles of acute severe pancreatitis combined with pancreatic abscess or infected pancreatic necrosis

目的通过对比分析急性重症胰腺炎(ASP)患者伴发胰腺脓肿(PA)或胰腺感染坏死(IPN)的诊疗过程,以确定ASP严重并发症的临床治疗原则,达到降低疾病病死率的目的。方法回顾性分析2007年1月—2013年6月期间普通外科收治的44例ASP患者临床资料及诊治经过,其中伴发PA者占27.3%(12/44),伴发IPN者占72.7%(32/44),总结对比2种并发症各自的临床表现、采取的治疗措施及治疗效果。结果 12例ASP伴发PA患者中,8例行经皮穿刺置管引流术,4例行胰腺脓肿切开引流术,手术治疗有效率100%,且术后均康复出院;32例ASP伴发IPN患者均行清创引流术,其中2例因出现多器官功能衰竭死亡,病死率为4.5%(2/44),余30例均康复出院;所有康复患者出院后行腹部超声及腹部CT复查,结果显示胰腺轮廓较清晰,密度均匀,无明显液性暗区,肝、肾功能基本恢复正常。结论胰腺脓肿(PA)和胰腺感染坏死(IPN)作为急性胰腺炎常见并发症,两者的发病原因及治疗方法存在很大的不同;针对ASP伴发的PA患者,宜及时行脓肿切开引流术,大多数能达到较好的治疗效果;而针对ASP伴发的IPN患者,临床上宜采取延迟手术干预的策略,这样才能够有效降低病死率。

Objective To determine the clinical treatment principles of serious complications of acute severe pancreatitis （ASP） and decrease the mortality through comparing the diagnosis and treatment methods between pancreatic abscess （PA） and infected pancreatic necmsis （ IPN ）. Methods The clinical data of 44 ASP patients from Jan. 2007 to Jun. 2013 in department of general surgery in our hospital were analyzed retrospectively, including 12 cases of PA accounting for 27.3% and 32 cases of IPN accounting for 72.7% ;the clinical manifestations, treatment measures and treatment effects of PA and IPN were carefully analyzed and compared. Results Among 12 PA patients,8 patients underwent tube drainage by percutaneous puncture ,4 patients underwent open drainage ,and all patients were cured. All 32 IPN patients underwent debridement and drainage. 2 patients died of multiple organ dysfunction syndrome accounting for 4.5% and other 30 patients were cured. Abdominal ultrasonography and abdominal CT were performed during the follow-up visit in all 30 discharged patients, and revealed that a clear outline of pancreas with uniform density, and without obvious liquid dark space ; and functions of liver and kidney were nearly recovered. Conclusion PA and IPN are the common complica- tions of acute severe pancreatitis, the different etiology of them require differential treatments. The open drainage could be adopted for the patients of PA in time while delayed surgical intervention could be adapted to the patients of IPN then the mortality rate may be reduced.