重症急性胰腺炎早期实施坏死胰腺清除及腹腔镜置管引流的手术技巧和临床疗效

The techniques and clinical efficacy of carrying out necrosis tissue clearance and catheter drainage by laparoscopic surgery in patients with severe acute pancreatitis

目的探讨重症急性胰腺炎（SAP）早期腹腔镜置管引流的手术技巧和临床疗效。方法回顾性分析我院2007年1月至2014年12月期间早期进行腹腔镜手术置管引流的54例SAP病人的临床资料,全部病例均应用腹腔镜微创技术行胃结肠韧带切开,胰腺被膜切开减压,清除胰周积液及坏死组织,并置多管持续灌洗引流。结果 1例因术中出血中转开腹手术,1例因小肠损伤开腹小切口修补。置管引流的手术时间102~185 min,平均128 min,治愈50例;住院时间17~106 d,中位时间31.5 d。4例死亡,1例死于多器官功能衰竭,1例死于合并胰腺癌,2例死于迟发腹腔出血并失血性休克,死亡时间分别为术后4 d、21 d、33 d、36 d,1例术后32 d因胰周脓肿再次行腹腔镜手术,3例胰腺假性囊肿,1例保守治疗治愈,2例经穿刺引流后治愈。结论早期采用腹腔镜置管引流手术治疗SAP,可有效地改善SAP的愈后,是一种有效的治疗方法。

Objective To investigate the techniques and clinical efficacy in severe acute pancreatitis （SAP） catheter drainage by laparoscopic surgery. Methods The clinical data of 54 patients with SAP, who were admitted to the First People＇s Hospital of Shunde and underwent the early laparoscopic surgery catheter drainage from January 2007 to December 2014, were retrospectively analyzed. Results Of the 54 cases, one case was converted to open surgery because of bleeding, one case was underwent the abdominal incision repair because of intestinal damage. The operation time ranged from 102 to 185 rain and the average was 128 min. Fifty cases were cured, and the hospitalization time was 17-106 days （the median time was 30.5 days）. Four cases were died, in whom one case died of multiple organ failure, one case died of pancreatic cancer and two cases died of delayed abdominal bleeding and hemorrhagic shock. The time of death were 4 days, 21 days, 33 days and 36 days, respectively. One case underwent the second laparoscopic surgery in 32 days after the first operation because of pancreatic abscess. Three cases became to pancreatic pseudocyst. One case was cured with conservative treatment. Two cases were cured after puncture and drainage. Conclusion Early laparoscopic surgery catheter drainage can effectively improve the prognosis of SAP, and becomes an effective method of treatment.