经皮穿刺引流在重症急性胰腺炎治疗中的价值

The value of percutaneous catheter drainage for severe acute pancreatitis

目的探讨重症急性胰腺炎(SAP)经皮穿刺引流治疗的临床价值及应用方法。方法回顾性分析15例经皮穿刺治疗的重症胰腺炎病人,平均穿刺时间距发病25.4天,B超引导下穿刺8例,CT引导下穿刺6例,CT联合B超引导1例;15例病人均穿刺成功,留置导管,冲洗引流,引流不畅者更换引流或软镜下清创,观察治疗效果。结果 15例病人全部穿刺成功,13例病人治愈,2例再次手术,胰瘘1例,肠瘘2例,均保守治愈,多器官功能衰竭死亡1例。结论影像引导下的经皮穿刺引流创伤小、恢复快,若选择合适的穿刺时机和正确的穿刺点以及引流方法,可作为临床治疗SAP胰周感染的首选方法。

Objective To evaluate the clinical value and method of percutaneous catheter drainage （PCD） for severe acute pancreatitis （SAP）. Methods 15 patients with SAP were retrospectively analyzed. The mean draining time was 25.4 days after the onset of disease. Of 15 cases, 8 cases received B ultrasound guided PCD, 6 cases underwent CT guided PCD and 1 case was given CT and B ultrasound guided PCD at the same time. The 15 operations were all successful. The indwelling pigtail catheter was washed intermittently. The catheter was replaced for tube blockage or debridement with soft microscopy. Results All 15 patients were suceessfully drained. 13 patients were cured and 2 patients received surgical intervention again. The complications included pancreatic leakage （1 case） and intestinal fistula （2 cases）. All were cured with conservative treatment. 1 patient died of MODS. Conclusion The image guided percutaneous puncture has little trauma and patients recover quickly. It can be the first choice to cure peripancreatic infection of SAP when we choose the appropriate puncture time, the correct puncture point and drainage method.