胰周贯穿式冲洗引流用于感染性胰腺坏死疗效分析

Peripancreatic transfixing irrigation-drainage for postoperative residual infected pancreatic necrosis

目的探讨胰周贯穿式冲洗引流用于感染性胰腺坏死的临床疗效。方法回顾性分析2011年1至2015年12月河南科技大学第一附属医院普外科行手术治疗的43例急性胰腺炎病人的临床资料。按术后冲洗引流方式分为贯穿冲洗组和网膜囊灌洗组,其中贯穿冲洗组病人术中安置胰周贯穿式冲洗引流管;网膜囊冲洗组病人术中安置小网膜囊灌洗引流管。观察并比较两组病人术后发生严重并发症、再手术、死亡以及胰周感染控制情况。结果术后贯穿冲洗组22例均治愈,4例发生严重并发症;网膜囊灌洗组21例病人中治愈17例,13例发生严重并发症,死亡4例。除外治愈率(100.0%vs.81.0%),两组病人的严重并发症发生率(18.2%vs.61.9%)、病死率(0 vs.19.0%)、再手术率(0 vs.66.7%)、术后引流管通畅率(100.0%vs.60.7%)以及住院时间[(30.6±9.4)d vs.(70.5±30.7)d]差异均有统计学意义(P<0.05)。两组病人术后胰周引流液细菌培养阳性率均呈下降趋势。术后第4周,贯穿冲洗组胰周残余感染6例,网膜囊灌洗组为18例,差异有统计学意义(P<0.01)。结论胰周贯穿式冲洗引流是急性胰腺炎术后残余感染性胰腺坏死的有效引流方法。

Objective To develop an effective postoperative peripancreatic irrigation-drainage method for infected pancreatic necrosis （IPN） after operation. Methods The clinical data of 43 cases of acute pancreatitis （AP） received surgical treatment in the First Affiliated Hospital, Henan University of Science ＆ Technology from January 2011 to December 2015 were analized retrospectivly. According to the postoperative peripancreatic drainage method, the cases were divided into groups A （n=22, peripancreatic transfixing irrigation-drainage, PTID） , and group B （n=21, continuous lavage of the lesser and retroperitoneum）. For the patients in group A, PTID tubes were placed in operation. For the patients in group B, the lesser and retroperitoneum tubes were placed in operation. For the two groups, the incidence of severe complications, re-operation, death, and peripancreatic residual necrosis infections were observed and compared. Results For group A, all 22 cases recoveried including 4 severe complications. For group B, 17 cases recoveried and 4 died, including 13 severe complications. Except for the recovery rate （ 100% vs. 81.0% ）, the rates of severe complications （ 18.2% vs. 61.9% ）, death （0 vs. 19.0% ）, re-operation （ 0 vs. 66.7% ）, draining patency （ 100% vs. 60.7% ）, and days of hospital stay [ （30.6±9.4）d vs. （70.5±30.7）d ] of the two groups were all different statisticaly（P〈0.05 ）. The positive rate of post-operation peripancreatic fluide germiculture decreased both. At the 4th week after operation, there were 6 cases of peripancreatic residual infection in group A, and 18 cases in group B, with statistical difference（P〈0.01 ）. Conclusion PTID is an effective drainage method with high draining patency, which can be used to clean the residual infected necrosis after infected necrotizing pancreatitis operation.