急性出血坏死型胰腺炎合并胰腺周围大量积液不同处理方式的疗效

Comparison of the Therapeutic Effects of Severe Acute Pancreatitis Combined with Large Amount of Effusion around the Pancreas

目的:探讨急性出血坏死型胰腺炎合并胰腺周围大量积液不同处理方式的疗效。方法:收集笔者所在医院2015年12月-2017年12月收治的经临床确诊的急性出血坏死型胰腺炎合并胰腺周围大量积液患者101例,患者分为A组(经后腹腔微创清创手术,49例)、B组(经皮导管引流,52例)。对比各组术后血淀粉酶恢复正常时间、症状体征缓解时间、膀胱压下降至正常时间、腹腔内积液大体吸收时间及总住院天数等临床指标。随访6个月并统计各组并发症发生率、治疗有效率及再手术率。结果:B组患者体征缓解时间、血淀粉酶恢复正常时间、腹腔内积液大体吸收时间、膀胱压下降至正常时间及总住院天数均短于A组,差异均有统计学意义(P<0.05)。B组患者并发症发生率低于A组,差异有统计学意义(P<0.05),两组治疗总有效率和再手术率对比差异无统计学意义(P>0.05)。结论:影像导引下经皮导管引流及经后腹腔微创清创手术对治疗急性出血坏死型胰腺炎合并胰腺周围大量积液疗效相当,但经皮导管引流操作相对简单,术后康复时间短,并发症发生率低,推广更容易。

Objective:To investigate the efficacy of different treatments for acute hemorrhagic necrotic pancreatitis combined with massive effusion around the pancreas.Method:A total of 101 patients with acute hemorrhagic necrotic pancreatitis and a large amount of effusion around the pancreas admitted to our hospital from December 2015 to December 2017 were enrolled.The patients were divided into group A(minimally invasive debridement after posterior abdominal cavity surgery,49 cases),group B(percutaneous catheter drainage,52 cases).The clinical indexes of postoperative blood amylase recovery time,symptom and symptom relief time,bladder pressure drop to normal time,gross absorption time of peritoneal effusion and total hospitalization days were compared.The patients were followed up for 6 months and the incidence of complications,treatment efficiency and reoperation rate were counted.Result:The recovery time of the signs,the normal time of blood amylase recovery,the time of total absorption of intra-abdominal effusion,the decrease of bladder pressure to normal time and the total length of hospital stay in group B were significantly shorter than those in group A,and the differences were statistically significant(P<0.05).The incidence of complications in group B was significantly lower than that in group A(P<0.05).There was no significant difference between the two groups in treatment efficiency and reoperation rate(P>0.05).Conclusion:Percutaneous catheter drainage and posterior abdominal minimally invasive debridement are effective in treating acute hemorrhagic necrotic pancreatitis with large amount of effusion around the pancreas,but percutaneous catheter drainage is relatively simple and the postoperative recovery time is short.The incidence of complications is low and promotion is easier.