早期内镜治疗重症急性胰腺炎并发腹腔内高压/腹腔间隔室综合征的效果研究

Clinical study of early endoscopic therapy for severe acute pancreatitis complicated with intra-abdominal hypertension/abdominal compartment syndrome

目的探讨软式内镜下腹腔灌洗透析对重症急性胰腺炎(SAP)急性反应期并发腹腔内高压(IAH)/腹腔间隔室综合征(ACS)的治疗作用。方法 32例急性反应期并发IAH/ACS的SAP患者在内科常规治疗的基础上给予软式内镜下腹腔灌洗透析治疗,动态监测腹内压(IAP)、急性生理与慢性健康评分(APACHE-Ⅱ)、腹膜刺激征评分的变化及肠鸣音恢复情况;比较治疗前后血清、腹水中肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平及腹水淀粉酶含量的变化;统计住院时间及预后。结果该组患者治愈30例(93.75%),转科2例(6.25%),平均住院(16.53±5.30)d。治疗后1周内随治疗时间延长,患者肠鸣音逐渐恢复,IAP、APACHE-Ⅱ评分及腹膜刺激征评分明显降低(P<0.05),血清TNF-α、IL-6水平及腹水中TNF-α、IL-6、淀粉酶水平明显下降(P<0.05)。结论软式内镜下腹腔灌洗透析是治疗SAP急性反应期并发IAH/ACS的有效方法,尽早治疗疗效好,具有微创、并发症少的优点。

Objective To investigate the effects of peritoneal lavage and dialysis by flexible endoscope in patients with early phase severe acute pancreatitis （SAP） complicated with intra-abdominal hypertension （IAH）/ abdominal compartment syndrome （ACS）. Methods 32 patients with early phase SAP complicated with IAH/ACS were received peritoneal lavage and dialysis by fexible endoscope in base of routine treatment. The release time of peritoneal irritation sign, the duration of intra-abdominal hypertension （IAP）, bowel sound, APACHE-II scores and prognosis of the patients were evaluated. The levels of TNF-α and IL-6 in serum, also, the concentrations of TNF-α, IL-6 and amylase in ascites/peritoneal lavage fuid were measured. Results 30 patients were all cured after treatment, with an average hospital stay of （16.53 ± 5.30） d, and, 2 patients underwent surgical treatment. The difference between before and after treatment was signifcance in peritoneal irritation sign scores, bowel sound, IAP and APACHE-II scores of the patients （P 〈 0.05）. The levels of testing items in serum and ascites/peritoneal lavage fuid were decreased signifcantly during peritoneal lavage and dialysis. Conclusion Continuous peritoneal lavage and dialysis by fexible endoscope is a safe and effective method for patients with SAP complicated with IAH/ACS, especially in the early stage of disease.