经腹膜后路径微创治疗重症急性胰腺炎合并胰周坏死十例临床分析

Clinical analysis of 10 patients with severe acute pancreatitis with peripancreatic necrosis treated by minimally invasive technique of retroperitoneal approach

目的评价经腹膜后路径微创技术治疗重症急性胰腺炎（SAP）合并胰周坏死的疗效。方法回顾性分析南华大学附属第一医院肝胆胰外科2016年1月至2016年9月收治的10例在常规综合治疗的基础上采取B超引导下经腹膜后间隙穿刺置管引流术治疗的SAP合并胰周坏死患者的临床资料。结果10例患者均穿刺成功。7例患者穿刺置管后引流通畅，3～7d淀粉酶恢复正常，2～4d腹痛、腹胀症状明显好转；3例因坏死范围较大及置管引流效果不佳，改行经皮肾镜腹膜后入路胰腺坏死组织清除术。7例引流液细菌培养呈阳性。所有患者穿刺过程中均未出现气胸、血胸、脏器损伤等并发症，平均住院时间为19．4d（10-34d）。结论经腹膜后路径微创治疗SAP合并胰周坏死安全、有效，疗效较好，值得临床推广应用。

Objective To evaluate the efficacy of minimally invasive technique by retroperitoneal approach in the treatment of severe acute pancreatitis with peripancreatic necrosis. Methods The clinical data of 10 patients with severe acute pancreatitis combined with peripancreatic necrosis who underwent retroperitoneal drainage by aspirating and placing tube under B ultrasound guidance on the basis of routine therapy in the First Affiliated Hospital of University of South China from January 2016 to September 2016 were analyzed. Results All of the 10 patients successfully underwent puncture. Drainage was good after puncture and tube placement in 7 patients. The amylase activity was normal within 3 ~ 7 days, and the symptoms of abdominal pain and bloating were alleviated in 2- 4 days. Among them, 3 cases had poor drainage after catheterization due to a large necrotic area, and the percutaneous nephroscope was performed to remove the necrotic tissue of the pancreas. Bacteria was detected in the drainage fluid of 7 patients. The complications of pneumothorax, hemothorax and organ injury were not found in all the patients. The average hospitalization time was 19.4 days （ 10 ~ 34 days）. Conclusions Minimally invasive retroperitoneal approach is safe and effective in curing severe acute pancreatitis with peripancreatic necrosis with good efficacy, which is worth for clinical recommendation and application.