经皮穿刺置管引流SAP合并胰腺坏死组织感染的临床效果分析

Clinical analysis of percutaneous catheter drainage in treating SAP combined with pancreatic necrosis

目的 探讨经皮穿刺置管引流治疗重症胰腺炎（SAP）合并胰腺周围组织坏死感染患者的临床效果及安全性。方法 选取2011年1月至2015年8月98例SAP并胰腺周围组织坏死感染患者进行回顾性分析,其中47例患者采用经皮穿刺置管引流术治疗（引流组）,51例患者采用开腹手术治疗（开腹组）,对比两种方法的治疗效果差异。统计软件采用SAS9.1,两组间急性生理与慢性健康评分（APACHEⅡ）、CT严重程度指数、WBC、血淀粉酶、尿淀粉酶、血糖、血钙值等采用均数±标准差（x±s）进行描述,比较采用t检验;全身炎症反应综合征（SIRS）发生率、入器官衰竭发生率、并发症发生率采用χ2检验,P值〈0.05表示差异有统计学意义。结果 治疗前和治疗后,引流组和开腹组两组间的WBC、血淀粉酶、尿淀粉酶、血糖、血钙值差异无统计学意义（P〉0.05）;治疗后,两组的WBC、血淀粉酶、尿淀粉酶、血糖值较本组治疗前均显著的降低（P〈0.05）。引流组的治愈出院率93.62%（44/47）与开腹组的92.16%（47/51）差异无统计学意义（χ^2=0.079,P=0.779〉0.05）;引流组患者的术后腹腔出血率、胰瘘率显著的低于开腹组患者（P〈0.05）。结论 对于胰腺坏死感染范围〈30%的SAP患者,采用经皮穿刺置管引流同样具有手术效果可靠,并且并发症低的优点。

Objective To investigate the clinical efficacy and safety of percutaneous catheter drainage in the treating severe acute pancreatitis （SAP） complicated with pancreatic necrosis. Methods From January 2011 to August 2015, clinical data of 98 patients with SAP and pancreatic necrosis were analyzed retrospectively, including 47 cases received percutaneous catheter drainage （Drainage Group） and 51 cases underwent open surgery （open group）. Statistical analysis were performed by using SAS9. 1 software. Measurement data were represented as （x ＋ s） and examined by using t test, including acute physiology and chronic health score （APACHE II）, CT severity index, WBC, serum amylase, urine amylase, glucose and serum calcium. SIRS incidence, the incidence of organ failure and complication rate were examined by using χ^2 test. A P value of 〈 0.05 was considered as significant difference. Results There were no significant difference between drainage group and laparotomy group of WBC, serum amylase, urine amylase, glucose, serum calcium before and after treatment （P 〉 0. 05 ）. After treatment, WBC, serum amylase, urine amylase, blood glucose decreased significantly compared with those before treatment in both groups （P 〈 0.05）. There was cure rate of 93.62% （44/47） in drainage group and 92. 16% （47/51） in laparotomy group, with no significant difference （χ^2 =0.079, P = 0.779 〉 0.05）. Postoperative incidence of abdominal bleeding and pancreatic fistula in drainage group was significantly lower than those in laparotomy group （P 〈 0. 05 ）. Condusion For patients with SAP and pancreatic necrosis of 〈 30%, Similar clinical outcome could be achieved by using percutaneous catheter drainage compared with surgical treatment, with less complications.