经B超或CT定位引流处理重症急性胰腺炎合并胰腺周围大量积液治疗体会

Treatment of severe acute pancreatitis with massive peripancreatic effusion by B-ultrasound or CT guided drainage

目的探讨重症急性胰腺炎(SAP)合并胰腺周围大量积液不同处理方式的疗效。方法收集本院2013年3月至2018年3月收治的经临床确诊的SAP合并胰腺周围大量积液患者218例,患者分为A组(保守治疗,93例),B组(腹腔镜,42例),C组(穿刺引流,83例)。观察症状体征缓解时间、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。统计并发症发生率、治疗有效率、再手术率及病死率。比较各组治疗总体费用。结果B、C组患者在体征缓解时间、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等疗效指标对比差异无统计学意义,且均优于A组,差异均有统计学意义(P<0.05)。B、C组患者并发症发生率、治疗有效率、再手术率及病死率对比差异无统计学意义,且均优于A组,差异均有统计学意义(P<0.05)。C组总体治疗费为(9743.15±1012.32)元明显低于A组(31231.62±1159.12)元及B组(24231.77±1209.42)元,差异有统计学意义(P<0.05)。结论B超或CT引导下穿刺置管引流及腹腔镜后入路置管引流对治疗SAP合并胰腺周围大量积液疗效相当,但穿刺置管引流总体医疗费用低,操作相对简单。

Objective To explore the effect of severe acute pancreatitis(SAP)combined with pancreas around a large number of different treatment methods.Methods A total of 218 patients with colorectal effusion were collected from March 2013 to March 2018.The patients were divided into group A(conservative treatment,93 cases),group B(laparoscopy,42 cases),group C(puncture drainage,83 cases).Observation of symptoms and signs of remission time,blood amylase returned to normal time,intraperitoneal fluid absorption time,bladder pressure dropped to normal time and total length of hospital stay.Statistical complication rate,treatment efficiency,reoperation rate and mortality.Compare the overall cost of each group.Results There was no significant difference in the curative effect between B and C patients in the time of symptom remission,normal time of blood amylase recovery,general absorption time of intraperitoneal effusion,decrease of bladder pressure to normal time and total length of hospital stay A group,the difference was statistically significant(P<0.05).There were no significant differences in the incidence of complications,treatment efficiency,reoperation rate and mortality between group B and group C,and were significantly higher than those in group A(P<0.05).The overall treatment cost of group C was(9 743.15±1 012.32),which was significantly lower than that of group A(31 231.62±1 159.12)and group B(24 231.77±1 209.42),the difference was statistically significant(P<0.05).Conclusion B-ultrasound or CT-guided percutaneous drainage and laparoscopic catheter drainage are similar to those in the treatment of SAP.However,the overall cost of medical treatment is low and the operation is relatively simple and suitable for large-scale promotion.