经皮穿刺置管引流与直接开腹手术引流治疗重症急性胰腺炎的疗效比较

PERCUTANEOUS CATHETER DRAINAGE EFFECT AND DIRECT OPEN OPERATION DRAINAGE IN THE TREATMENT OF SEVERE ACUTE PANCREATITIS COMPARISON

目的：比较经皮穿刺置管引流与直接开腹手术引流在合并胰腺坏死组织感染的重症急性胰腺炎（SAP）病人中的临床疗效。方法：回顾性分析2012-01~2013-12我科治疗的97例合并胰腺坏死组织感染的重症急性胰腺炎（SAP）病人的临床资料,根据对胰腺坏死组织感染的治疗方法不同,将病人分为经皮穿刺置管引流组（观察组）41例和直接开腹手术引流组（对照组）56例。经皮穿刺置管引流组在超声引导下穿刺置管引流,冲洗3 d后如无明显改善则中转开腹手术引流;直接开腹手术引流组在确诊胰腺坏死组织感染后直接开腹手术引流。对两组病人的疗效（治疗前后的实验室检查指标、治愈率、总有效率、并发症发生率、病死率）、平均住院时间、平均住院费用进行对比分析。结果：经皮穿刺置管引流组（观察组）治愈率68.29%,总有效率87.80%;直接开腹手术引流组（对照组）治愈率42.85%,总有效率66.07%;两组比较差异有统计学意义（P〈0.05）;经皮穿刺置管引流组（观察组）术后胰瘘（2.44%比21.43%,P〈0.05）、肠瘘（4.88%比21.43%,P〈0.05）、胰周出血（7.32%比25.00%,P〈0.05）、术后残余脓肿（12.20%比30.36%,P〈0.05）的发生率均低于直接开腹手术引流组（对照组）;经皮穿刺置管引流组（观察组）病死率7.32%;直接开腹手术引流组（对照组）病死率21.43%;两组比较差异无统计学意义（P〉0.05）;经皮穿刺置管引流组（观察组）白细胞总数、血淀粉酶、尿淀粉酶、血糖、血钙等实验室检查指标与直接开腹手术引流组（对照组）比较差异有统计学意义（P〈0.05）;经皮穿刺置管引流组（观察组）平均住院时间、平均住院费用与直接开腹手术引流组（对照组）比较差异有统计学意义（P〈0.05）。结论：经皮穿刺置管引流能有效缓解重症急性胰腺炎的症状,提高治愈率和总有效率,降低并发症发生率和病死率,缩短平均住院时间、减少平均住院费用,较直接开腹手术引流效果好,具有更好的临床应用价值。

Objective： To compare percutaneous catheter drainage and direct openoperation drainage in pancreas tissue necrosis infection in patients with severe acute pancreatitis（ SAP） in patients with clinical efficacy. Methods： Retrospective analysis of 2012 January to 2013 December in our department treated 97 cases of pancreatic tissue necrosis infection in patients with severe acute pancreatitis（ SAP）in patients with clinical data,according to the different ways for treatinginfective pancreatic necrosis,the patients were divided into percutaneous catheter drainage group（ observation group） 41 cases and direct open operationdrainage group（ control group） 56 cases. Percutaneous catheter drainage group in ultrasound guided percutaneouscatheter drainage,rinse after 3 D as no significant improvement in conversion to open surgery drainage; direct laparotomy group in pancreatic tissue necrosisconfirmed infected directly to open drainage. The efficacy of the two groups（ before and after the treatment,laboratory index,cure rate,the total efficiency,complication rate,mortality rate）,the average hospitalization time,average hospitalization expenses for comparative analysis. Results： Percutaneous catheterdrainage group（ observation group） 68. 29% cure rate,the total efficiency of 87. 80%; direct Laparotomy Operation drainage group（ control group） the cure rate was 42. 85%,the total efficiency of 66. 07%; there was significant difference between two groups（ P 〈0. 05）; percutaneous catheter drainage group（ observation group） operation after pancreatic fistula（ 2. 44% vs 21. 43%,P〉 0. 05）,intestinal fistula（ 4. 88%vs 21. 43%,P〉 0. 05）,pancreatic hemorrhage（ 7. 32% vs 25%,P 0. 05）,residual abscess after operation（ 12. 20% vs 30. 36%,P〉 0. 05） incidence rate is lower than the direct abdominal operation drainage group（ control group）; percutaneous catheter drainage group（ observation group） the mortality rate was 7. 32%; the direct abdominal operation drainage group（ control group） the mortality rate was21. 43%; the difference between the two groups had no statistical significance（ P 〈0. 05）; percutaneous catheterdrainage group（ observation group） index to check the total white cell count,serum amylase,urine amylase blood glucose,serum calcium,laboratory and direct open operation drainage group（ control group） the difference was statistically significant（ P 〈0. 05）; percutaneous catheter drainage group（ observation group） the average hospital stay,average hospitalization expensesand direct open operation group（ drainage The control group） the difference was statistically significant（ P 〈0. 05）. Conclusion： Percutaneous puncture catheter drainage can effectively relieve the symptoms of severe acute pancreatitis,improve the cure rate and total effective rate,reduce the incidence of complications and mortality rate,shortening the average hospitalization time,reduce the average hospitalization expenses,the more direct Laparotomy Operation drainage effect is good,has better clinical application value.