腹腔穿刺引流用于急性胰腺炎并液体积聚观察

Abdominal paracentesis drainage ahead of percutaneous catheter drainage benefits acute pancreatitis patients with fluid collection: a retrospective clinical control study

目的:评估早于经皮穿刺置管引流(PCD)进行腹腔穿刺引流(APD)的有效性,以代替单独经皮穿刺置管引流(PCD-alone),作为升阶梯治疗的新的第2步治疗方法。方法:以2009年6月到2011年6月入院的102例急性胰腺炎患者为研究对象,根据是否行APD将患者分为APD+PCD组53例和单独PCD组49例。通过回顾性分析,比较其术后死亡率、反复发作急性胰腺炎和慢性胰腺炎的发生率、器官衰竭、远期干预等。结果:APD+PCD组死亡率3.77%,单独PCD组死亡率8.16%,APD+PCD组显著低于单独PCD组(P<0.05)。经2年随访,APD+PCD组反复发作急性胰腺炎及慢性胰腺炎发生率分别为7.84%、5.88%,单独PCD组反复发作急性胰腺炎及慢性胰腺炎发生率分别为14.29%、8.16%,APD+PCD组显著低于单独PCD组(P<0.05)。APD+PCD组较单独PCD组器官衰竭数少,从发病到远期干预的时间明显延迟,住院费用较低。结论:早于PCD进行APD有益于患者,且方法简单实用,值得临床推广。

Objective: To evaluate the efficacy of abdominal paracentesis drainage( APD) ahead of percutaneous catheter drainage( PCD) in the replacement of PCD-alone treatment as the new second step of a step-up approach for acute pancreatitis( AP). Methods: 102 consecutive AP patients were admitted from June 2009 to June 2011. According to whether or not APD was applied,they were divided into two groups: 53 Patients in APD + PCD group,49 ones in PCD-alone group. Observed parameters mainly included mortality,the incidence of recurrent AP or chronic pancreatitis( CP),organ failures and the indexes of further interventions. Results: The mortality rate in the APD + PCD group was 3. 77% while the PCD-alone group was8. 16%; the APD + PCD group showed significantly lower mortality rate than the PCD-alone group( P < 0. 05). After 2-year followup,the incidence of recurrent AP and CP in the APD + PCD group was 7. 84% and 5. 88% while the PCD-alone group was14. 29% and 8. 16%,respectively; the APD + PCD group showed significantly lower recurrent incidence than the PCD-alone group( P < 0. 05). Compared with the PCD-alone group,the number of organs failed was decreased,the interval from the onset of AP to further interventions was remarkably delayed,and the cost of hospitalization significantly reduced in the APD + PCD group.Conclusion: APD ahead of PCD is beneficial to AP patients,which is simple and worthy of clinical application.