经皮穿刺置管引流治疗急性重症胰腺炎合并胰腺周围组织坏死感染的效果观察

Percutaneous catheter drainage for acute severe pancreatitis complicated with peripancreatic necrosis and infection

目的:探讨经皮穿刺置管引流术(PCD)治疗急性重症胰腺炎(SAP)胰腺周围组织坏死感染的临床效果。方法:回顾性分析对113例手术治疗的SAP合并胰腺周围组织坏死感染(胰腺坏死范围<30%)患者资料,其中采用PCD治疗54例(PCD组),采取直接开腹手术引流治疗的有59例(开腹组),对比两组患者的相关临床指标。结果:两组治疗前白细胞、血淀粉酶、尿淀粉酶、血糖值、血钙值差异均无统计学意义(均P>0.05),治疗后两组以上实验室指标均较各自治疗前明显改善(均P<0.05)。治疗后比较,PCD组血淀粉酶、尿淀粉酶、血糖值均明显低于开腹组患者(均P<0.05);PCD组住院时间、住院费用、死亡或放弃治疗率均明显的低于开腹组(均P<0.05);两组治疗有效率(79.6%vs.81.4%)、引流液体细菌培养结果差异均无统计学意义(均P>0.05)。结论:PCD治疗SAP合并胰腺周围组织坏死感染(胰腺坏死范围<30%)的效果确切,同时具有缩短住院时间、减少住院费用的优势。

Objective： To investigate the clinical efficacy of percutaneous catheter drainage（PCD） in the treatment of acute severe pancreatitis（SAP） complicated with peripancreatic necrosis and infection. Methods： The clinical data of 113 SAP patients with peripancreatic necrosis and infection（range of pancreatic necrosis30%） undergoing surgical treatment were analyzed retrospectively. Of the patients, 54 cases received PCD treatment（PCD group）, and 59 cases were subjected to direct open drainage（laparotomy group）. The relevant clinical variables between the two groups of patients were compared.Results： There was no significant difference in white blood cell count, and levels of serum amylase, urine amylase, blood glucose and serum calcium between the two groups（all P〈0.05）, and all above parameters were significantly improved in both groups compared with their preoperative values（all P〈0.05）. Postoperative comparison showed that the levels of serum amylase, urine amylase and blood glucose in PCD group were significantly lower than those in laparotomy group（all P〉0.05）, and the length of hospital stay, hospitalization costs, mortality rate and treatment abandonment were significantly reduced in PCD group compared with laparotomy group（all P〈0.05）. The effective treatment rate（79.6% vs. 81.4%） and results of drainage fluid bacterial culture showed no significant difference between the two groups（all P〉0.05）.Conclusion： PCD has demonstrable efficacy in treatment of SAP complicated with peripancreatic necrosis and infection（range of pancreatic necrosis30%）, and also has advantages of short hospital stay and reduced hospitalization expense.