重症急性胰腺炎合并大量胰周积液的治疗体会

Experience in the treatment of severe acute pancreatitis with a large amount of peripancreatic effusion

目的对18例重症急性胰腺炎合并大量胰周积液的患者进行穿刺置管引流和“升阶梯式”策略进行治疗,并进行疗效评价.结果显示,18例患者共进行28例次置管引流.所有患者穿刺过程顺利,无明显出血、脏器损伤、肠瘘等严重并发症.其中5例患者行单腔置管引流后临床症状缓解,腹腔积液消失.13例患者行多次置管引流,其中1例患者后期联合胆道镜下行坏死组织清除术,1例患者行手术治疗,18例患者全部治愈出院.表明应用穿刺置管引流和“升阶梯式”策略对重症急性胰腺炎合并大量胰周积液的治疗安全有效,值得在临床应用推广.

Objective 18 cases of severe acute pancreatitis with massive peripancreatic effusion were treated with puncture and drainage and " step up" strategy,and the curative effect was evaluated. The results showed that 18 patients underwent 28 times tube drainage. All patients had a smooth puncture, and no significant bleeding, organ injury, intestinal fistula and other serious complications. In 5 cases, the clinical symptoms were relieved and the peritoneal effusion disappeared after single cavity drainage. 13 patients underwent multiple catheterization and drainage, and among them 1 patient underwent necrotic tissue clearance combined with choledochoscope in late stage, and 1 patient underwent surgical treatment. 18 patients were cured and discharged. The results show that the use of puncture and drainage and " step up" strategy in the treatment of severe acute pancreatitis with a large number of peripancreatic effusion is safe and effective, and it is worth popularizing in clinical practice.