腔镜辅助经后腹膜入路清创术治疗重症胰腺炎胰周坏死感染

Retroperitoneai laparoscopic debridement therapy for infected severe acute pancreatitis

目的探讨腔镜辅助后腹膜小切口入路清创术治疗重症急性胰腺炎胰周坏死伴感染的安全性和有效性。方法回顾浙江大学医学院附属邵逸夫医院重症胰腺炎诊治中心自2014年8月至2015年10月收治的数例重症急性胰腺炎患者，选择分析其中行腔镜辅助后腹膜入路清创术治疗胰周坏死感染的6例患者临床资料。术中采用腔镜辅助，经后腹膜做小切口2cm入路，交替使用腔镜器械（抓钳、吸引器等）和卵圆钳清除腹膜后区的坏死感染组织，术后留置双套管持续冲洗。并对患者术后恢复情况进行分析总结。结果6例患者均成功完成了清创术，其中有2例患者前后进行了2次清创，其余均行1次清创；手术时间（220．0±58．3）min，清创术后平均住院时间62．6（35～117）d，6例患者中无死亡病例，术后均无新发的器官功能衰竭。1例患者清创术后33d因腹腔出血而再次手术止血，1例患者术后1个月复查提示并发胰腺假性囊肿。结论对于重症急性胰腺炎胰周坏死伴感染的患者，腔镜辅助小切口经后腹膜入路清创术是安全有效的，术中采用“卵圆钳-腔镜器械-卵圆钳”三步法保证了清创的彻底与安全，降低患者创伤，缩短住院时间，更加符合微创理念与加速康复外科（ERAS）理念。

Objective To investigate the feasibility and availability of retroperitoneal laparoscopic debridement therapy for patients with infected severe acute panereatitis. Methods Clinical data of 6 patients with severe acute pancreatitis who underwent retroperitoneal laparoseopic necrotic tissue debridement therapy in the Severe Acute Pancreatitis Center of Sir Run Run Hospital between August 2014 and October 2015 was retrospectively analyzed. The laparoscopic instruments and sponge forceps were used to remove necrotic tissue under retroperitoneal space, and double-cavity drainage tube was left for continuous washing. The perioperative indicators were collected and analyzed. Results Two of six patients underwent two surgeries, and the others underwent one surgery, with an average operation time of （220.0 ± 58. 3 ） minutes and a mean hospital stay time of 62. 6 days （35 - 117 days）. One patient underwent re-operation after 33 days because of intraperitoneal hemorrhage, and another patient suffered pancreatic pseudocyst after the surgery, but no one died in hospital. Conclusion Retroperitoneal laparoscopic debridement therapy is an additional choice for patients with infected severe acute pancreatitis, especially for those who had limited necrosis under retroperitoneal space. Furthermore, the therapy is in line with the concept of minimally invasive surgery and enhanced recovery after surgery.