腹腔镜术后腹腔灌洗、持续循环式腹膜透析治疗重症急性胰腺炎的临床研究

Peritoneal lavage and continuous circular peritoneal dialysis after laparoscopic operation in treatment of severe acute pancreatitis

目的观察腹腔镜术后腹腔灌洗、持续循环式腹膜透析(CCPD)治疗重症急性胰腺炎(SAP)的临床效果及安全性。方法将68例SAP患者随机分为治疗组32例与对照组36例,治疗组于腹腔镜下手术,术后灌洗引流与CCPD交替进行,病情稳定后(约需3 d)单一行腹腔灌洗;对照组给予常规治疗。结果治疗组急性生理与慢性健康评分(APACHEⅡ)及Balthazar CT积分从第1天即下降明显(P<0.05),而对照组在第3天才显著下降,且治疗组各时点积分均较对照组明显降低(P<0.05)。治疗组各时相点血浆中促炎细胞因子肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)及C反应蛋白(CRP)含量与治疗前比较呈明显降低趋势(P<0.01),白细胞介素-10(IL-10)含量呈明显升高趋势(P<0.01),与对照组比较各时点各细胞因子含量差异有统计学意义意义(P<0.05)。结论腹腔镜术后灌洗引流与CCPD治疗SAP具有方法简单、安全、快捷、创伤小、并发症少及无需抗凝等优点,无血液动力学影响,患者有较好的耐受性等特点,是一种治疗SAP的有效方法。

Objective To investigate the clinical effects and safety of peritoneal lavage and continuous circular peritoneal dialysis（CCPD） after laparoscopic operation in treatment of severe acute pancreatitis（SAP）. Methods 68 patients of SAP were randomly divided into treatment group and control group. 32 cases of treatment group were performed laparoscopic operation, and then treated with peritoneal lavage and continuous circular peritoneal dialysis alternatively. When the patient＇s condition was stable and serum amylase reduce to normal, only peritoneal lavage was used in the treatment. 36 cases of control group were treated with regular methods. Results The operation time,the hemorrhage amount of operation, the recovery time of serum index and the incidence of complication after operation were significantly decreased compared with those of the contrast group. The CT scores and APACHE Ⅱscores were significantly decreased on the first day in microtraumatic group and on third day in control group, and the scores on each observation point in microtraumatic group were lower than those in control group. The serum levels of proinflammatory cytokines TNF-α、IL-6、IL-8 and CRP were significantly decreased and the serum level of antiinflammatory cytokines IL-10 was significantly increased significantly after treatment in both groups. But the serum TNF-α、IL-6、IL-8 and CRP levels were higher and the serum IL-10 level was lower on each observation points in microtraumatic group than those in control group. Conclusions Peritoneal lavage and continuous circular peritoneal dialysis after laparoscopic operation is a simple, safe, quick, less traumatic, few complicated, no anticoagulant, easy tolerated and effective method in the treatment of severe acute pancreatitis.