早期微创后入路引流对重症急性胰腺炎炎症反应的影响

The effects of early stage minimally invasive retroperitoneal approach of drainage for severe acute pancreatitis

目的探讨早期微创腹腔镜后入路置管引流对重症急性胰腺炎（severe acute pancreatitis，SAP）患者早期炎症反应的疗效。方法将37例SAP且有腹腔积液患者，采用随机数表法分为早期腹腔镜后入路引流治疗组（观察组19例）和常规治疗组（对照组18例）。2组同时予以禁饮禁食、胃肠减压、预防感染、补液，制酸抑酶等常规治疗，观察组在此基础上给予早期腹腔镜后入路引流治疗。检测2组治疗前后血清肿瘤坏死因子（TNF）-a、白细胞介素（IL）-6、IL-8、IL-10及c反应蛋白（C-reactive protein，CRP）等急性炎症指标，观察恢复进食天数及急性生理和慢性健康评分（APACHEⅡ）变化，全身炎症反应综合征（systemic inflammatory response syndrome，SIRS）持续时间及多器官功能不全综合症（multiple organ dysfunction syndrome，MODS）的发生率及病死率。结果2组均有急性炎症反应发生。2组在治疗后第3天血清TNF-a、IL-6、IL-8、IL-10及CRP水平均呈下降趋势，在治疗后第7天常规治疗组炎症因子再次升高而早期腹腔镜后入路引流组继续保持明显下降，2组差异有统计学意义（P〈0．01）。观察组禁食时间、SIRS持续的时间明显短于对照组（P〈0．01），APACHEⅡ评分也明显优于对照组（P〈0．01），多器官功能不全综合症（multiple organ dysfunction syndrome，MODS）的发生率、总体并发症及病死率方面优于对照组，差异均具有统计学意义（P〈0．05）。结论早期腹腔镜后入路置管引流能快速有效改善SAP患者病情，清除患者血清中过多炎症因子，可改善SAP患者临床转归。

Objective To investigate the therapeutic effect of early stage minimally invasive laparoscopic retroperitoneal approach of catheter drainage on early inflammatory response of severe acute pancreatitis （SAP）. Methods 37 SAP patients with peritoneal effusion were divided into the observation group （19 cases with early laparoscopic retroperitoneal approach of catheter drainage） and normal treatment group （ 18 cases with conventional drainage） using a random number table. All patients were given conventional therapy, such as fasting, gastroin- testinal decompression, anti-infection, fluid resuitation and using gastric acid and trypsin inhibitors. In addition to conventional therapy, the observation group received the early laparoscopic retroperitoneal approach of catheter drainage. The inflammatory indexes responding to acute inflammation such as TNF~, IL-6, IL-8, IL-10 and C-re- active protein（ CRP）were detected before and after treatment. Meanwhile, the date of resume diet, APACHE II scores and duration of systemic inflammatory response（ SIRS）, incidence of multiple organ dysfunction syndrome （MODS） and the mortality were observed. Results The acute inflammatory response occurred in both,.groups. The plasma levels of TNF-a, IL-6, IL-8, IL-10 and CRP in the two groups decreased obviously after 3-day treatment. However, the plasma levels of inflammatory mediators in the normal treatment group increased while those early laparoscopic retroperitoneal approach of catheter drainage group kept decreasing after 7-day treatment. There was a significant difference between the two groups（P 〈0. 01 ）. Time for resuming to diets and duration of SIRS in the observation group were less than those in the normal treatment group （P 〈 0.01 ）, APACHE ]I score were significantly less than those in normal treatment group also（P 〈 0.01 ）. The rates of MODS, overall postoperative complication rate and mortality were significantly lower in the observation group （ P 〈 0. 05 ）. Conclusions Early laparoscopic retroperitoneal approach of catheter drainage can effectively improve the prognosis in patients with SAP and decrease the production of inflammatory mediators. Early laparoscopic retroperitoneal approach of cathe- ter drainage is simple, feasible and micro-invasive with encouraging outcomes, therefore it is an effective and safe treatment option for patients with SAP.