内镜介入联合腹腔镜灌洗治疗胆源性重症急性胰腺炎的临床疗效

Effect and safety study of endoscopic and laparoscopic lavage in the treatment of severe acute pancreatitis

目的探讨内镜介入联合腹腔镜灌洗治疗重症急性胰腺炎(SAP)的有效性与安全性。方法将60例SAP患者按照抽签方法随机地均分为对照组与观察组各30例。对照组采用内镜介入治疗,观察组在此基础上联合腹腔镜灌洗治疗。比较2组手术相关指标、炎性因子(TNF-α、IL-6及IL-8)水平变化、生活质量、并发症发生率。结果1手术指标:与对照组比较,观察组腹痛缓解时间[(2.45±0.18)h vs.(5.12±0.89)h]、体温正常时间[(3.98±1.07)d vs.(7.52±1.68)d]、肛门排气时间[(7.96±1.89)d vs.(14.02±3.72)d]、灌洗引流时间[(10.54±3.07)d vs.(15.38±3.29)d]、住院时间[(21.02±2.74)d vs.(35.97±3.08)d]均缩短,差异有统计学意义(P<0.05);2炎性因子水平:与对照组比较,观察组外周血TNF-α[(45.22±8.78)μg/L vs.(162.11±19.58)μg/L]、IL-6[(31.14±6.37)μg/L vs.(69.08±12.11)μg/L]、IL-8[(111.25±19.86)μg/L vs.(318.27±32.25)μg/L]均明显下降低于照组,差异有统计学意义(P<0.05);3生活质量:与对照组比较,观察组生活质量评分(142.16±10.32 vs.115.24±7.34)明显增加高于对照组,差异有统计学意义(P<0.05);4并发症:与对照组比较,观察组胰腺及周围组织坏死(6.67%vs.33.33%)、胰腺脓肿(3.33%vs.30.00%)、胰腺肠瘘(0.00%vs.33.33%)及胰腺假性囊肿发生率(6.67%vs.16.67%)均明显低于对照组,差异有统计学意义(P<0.05)。结论内镜介入联合腹腔镜灌洗治疗重症急性胰腺炎有助于降低术后炎性水平,改善临床症状,减少并发症发生率,提高生活质量。

Objective To study the effect and safety of endoscopic and laparoscopic lavage in the treatment of severe acute pancreatitis（SAP）. Methods 60 cases of patients with SAP were divided randomly into control group and observation group. Control group received endoscopic interventional therapy, observation group based on the combined laparoscopic lavage treatment. Operation indexes, inflammatory cytokines （ TNF-α, IL-6 and IL-8 ）, quality of life, complications were compared. Results （1）operation indexes： observation group abdominal pain relief time（2.45 ±0. 18 ）h, normal temperature time （ 3.98±1.07 ） d, anal exhaust time （ 7.96 ± 1.89 ） d, lavage drainage time （ 15.38±3.29 ） d, hospital stay （21.02 ± 2.74）d were significantly lower than those of control group; （2）inflammatory factors level： observation group TNF-α[ （45.22±8.78）μg/L vs. （162. 11 ± 19.58）μg/L] ,IL-6[ （31.14 ±6.37）μg/L vs. （69.08 ±12.11） μg/L], IL-8 [ （ 111.25 ±19.86 ） μg/L vs. （318.27 ± 32.25 ） μg/L ] were significantly lower than those of control group ;（3）quali- ty of life： observation group quality of life score（ 142.16 ± 10.32 vs. 115.24 ±7.34） was significantly higher than that of eontrol group;（4）eomplieations： observation group pancreas and surrounding tissue necrosis（6.67% vs. 33.33% ）, pan- ereatie abscess （ 3.33% vs. 30.00% ）, panereas fistula （0.00% vs. 33.33% ）, pancreatic pseudoeyst （ 6.67% vs. 16, 67 % ）were significantly lower than those of control group. Conclusion Endoscopic intervention combined laparoscopic lavage in treatment of severe acute pancreatitis was helpful to reduce the postoperative inflammatory level,improve the clinical symptoms, reduce complications, and improve the quality of life.