弥漫性胆汁性腹膜炎的序贯式微创化治疗研究

Study on sequential minimally invasive treatment of diffuse biliary peritonitis

目的探索微创化进阶策略治疗弥漫性胆汁性腹膜炎的临床实施方案及价值。方法回顾分析本中心应用微创化进阶策略治疗的36例弥漫性胆汁性腹膜炎患者的临床资料,统计患者治愈率、症状缓解率、近期及远期并发症发生率、住院时间等指标,分析微创化进阶策略在治疗弥漫性胆汁性腹膜炎中的临床价值。结果本组患者总的治愈率为97.22%(35/36);住院时间7~47 d,平均(22.0±5.5)d;死亡率2.78%(1/36);近期并发症发生率13.89%(5/36),其中急性胆管炎3例(8.33%,3/36),急性胰腺炎2例(5.56%,2/36);远期并发症发生率2.78%(1/36)。36例患者经过第一阶段介入超声多区域协同引流后,22例治愈,治愈率61.11%(22/36);12例(33.33%,12/36)患者进阶施行内镜下鼻胆管引流,10例(83.33%,10/12)治愈。进阶施行开腹手术的4例(11.11%,4/36)患者中,3例治愈,1例死亡。结论微创化进阶治疗策略是治疗医源性胆漏所致弥漫性腹膜炎的有效措施,基于微创技术的治疗模式有望成为治疗胆漏所致弥漫性腹膜炎的首选方案。

Objective To carry out the minimal invasion -based step -up approach strategy in the treatment of diffuse peritonitis caused by iatrogenic bile leakage, and to evaluate its clinical values. Methods We retrospectively analyze the 36 patients diagnosed with diffuse peritonitis caused by iatrogenic bile leakage and treated by minimal invasion - based step - up approach strategy from January 2010 to December 2015 in our center. The cure rate, symptom remission rate, shortterm and long- term complications occurrence rates, and hospitalization stay were analyzed to evaluated the minimal invasion - based step - up approach strategy in the treatment of diffuse peritonitis caused by iatrogenic bile leakage. Results In the current cohort, the total cure rate was 97.22% （35/36） ; the hospitalization stay was 22 d （7 d - 47 d） ; the mortality rate was 2. 78 % （1/36） ; the incidence rate of short -term complications was 13.89% （5/36）, ineluding 3 cases of acute cholangitis （8. 33% , 3/36） and 2 cases of acute panereatitis （5.56% , 2/36） ; the occurrence rate of long - term complications （2. 78% , 1/36）. After the first step with ultrasound - guided intervention, 22 patients were cured （61.11%, 22/36）, and 14 patients entered the following steps. There were 12 cases （33.33% , 12/36） received endoscopic nasobiliary drainage （ENBD） and 10 cases were cured. There were 4 patients （11.11% , 4/36） underwent laparotomy, among whom 3 cases were cured and 1 cases died. Conclusion Minimal invasion - based step - up approach strategies is effective on the treatment of iatrogenic bile leakage - induced diffuse peritonitis, and prospectively becomes the preferred option.