腹腔镜辅助经网膜囊胰腺坏死组织清除治疗感染性胰腺坏死疗效分析

Single step laparoscopic assisted trans-lesser sac debridement in treatment of peripancreatic infected pancreatic necrosis

目的评价"一步法"腹腔镜辅助经网膜囊胰腺坏死组织清除(LATLSD)治疗胰周感染性胰腺坏死(IPN)的疗效。方法回顾性分析2014年6月至2017年8月首都医科大学宣武医院普通外科实施LATLSD治疗的35例IPN病人资料,所有病例坏死积液均集中于胰周区域。观察术后24 h及术后1周生命体征及炎症指标。结果 35例病人均成功进行手术,初次手术时间为(78.9±25.3)min,出血量为20(10~600)ml,初次手术引流管数量为(3.8±1.0)根。平均手术次数(2.3±1.6)次。平均住院时间为(44.8±32.2)d。34例(97.1%)病人脓液细菌培养结果阳性。手术并发症发生率为17.1%(6/35),其中新发器官功能障碍4例(1例同时发生腹腔出血),胃漏、结肠漏各1例;发生Clavien-DindoⅢ级及以上并发症5例(14.3%)。病死率为5.7%(2/35),治疗成功率为94.3%。病人术后24 h白细胞水平较术前显著下降[(10.6±6.6)×109/L vs.(12.6±6.3)×109/L,P<0.01],而各项生命体征及炎症指标(白细胞总数、中性粒细胞百分比、C反应蛋白、降钙素原、白介素-6)在术后1周显著好转。结论 "一步法"LATLSD治疗胰周IPN安全、有效。

Objective To explore the safety and effectiveness of single step laparoscopic assisted trans-lesser sac debridement（LATLSD） in treatment of peripancreatic infected pancreatic necrosis. Methods 35 patients with infected pancreatic necrosis, who received single step LATLSD were included in this study and analyzed retrospectively. All cases of necrotic tissue and infected fluid were concentrated in the peripancreatic region. Technical success rate, treatment success rate, morbidity and mortality were recorded as main outcome. The secondly outcome including initial operation time, estimated blood loss, the vital sign and infection marker on postoperative 24 hour and 1week was also analyzed. Results All cases were underwent operation successfully. Operation time, estimated blood loss during the first operation was （78.9±25.3） min and 20（10-600）ml. （3.8±1.0） drains were placed in the initial procedure. The mean times of operation and hospital stay were （2.3±1.6） times and （44.8±32.2） days, respectively. Bacterial culture was positive in 34（97.1%） patients. The overall complication rate was 17.1%（6/35） , including new onset of organ dysfunction in 4 cases （1 case of simultaneous abdominal bleeding）, gastric leak in 1 case, colonic leakage in 1 case. Clavien-Dindo grade Ⅲ or severer complications occurred in 5 cases （14.3%）. The mortality was 5.7%（2/35） and the treatment success rate was 94.3%. The white blood cell count was decreased significantly on postoperative 24 hour[（10.6±6.6）×10^9/L vs. （12.6±6.3）×10^9/L ,P〈0.01],and the vital signs and infection markers significantly improved on postoperative 1 week. Conclusion Single step LATLSD was safe and effective in treatment of peripancreatic infected pancreatic necrosis.