1例重症急性胰腺炎后合并胰周包裹性坏死的治疗体会

Experience in treatment of 1 patient with peripancreatic walled-off necrosis after severe acute pancreatitis

目的探讨重症急性胰腺炎(SAP)后并发胰周包裹性坏死的治疗方式。方法回顾性分析重庆医科大学附属第二医院肝胆外科收治的1例SAP后并发胰周包裹性坏死病例的临床资料,对该例患者进行的多学科协作(MDT)讨论及治疗结果进行总结。结果该患者因SAP后高热、腹痛伴呼吸困难2周入院,上腹部增强CT提示SAP并胰周大量包裹性坏死、胸腔中量积液。经重庆医科大学附属第二医院SAP MDT团队充分讨论后决定在排除手术禁忌后于全麻下行经皮窦道胰周坏死组织清除术,经过两阶段经皮窦道胰周坏死组织清除术治疗后患者胰周坏死组织明显减少,引流通畅,临床症状及指标均较前明显改善,术后第6天出院。目前患者一般情况可,无明显临床症状。结论SAP病情凶险,进展快,并发症的干预时间点及方式选择很棘手,经皮经窦道胰周坏死组织清除术可早期治疗SAP合并感染性或包裹性坏死,相对传统方式具有创伤小、效率高及恢复快的优势。

Objective To investigate treatment of severe acute pancreatitis (SAP) concurrent peripancreatic walled-off necrosis. Methods The clinical data and treatment of a patient with SAP from the Second Affiliated Hospital of Chongqing Medical University were retrospectively analyzed. The results of discussion of multidisciplinary team (MDT) were summarized. Results The patient was admitted for the SAP with high fever, abdominal pain, and dyspnea for 2 weeks. The enhanced CT scan of the upper abdomen presented severe acute necrotizing pancreatitis with massive peripancreatic walled-off necrosis and pleural effusion. After the full discussion of SAP MDT, the percutaneous sinus tract necrosectomy (PSTN) was performed to relieved the symptom. After the two-stage PSTN treatment, the peripancreatic necrotic tissue was obviously reduced, the drainage was unobstructed, the clinical symptoms and biochemical indicators were obviously improved, and the patient was discharged on day 6 after the surgery. Conclusions SAP is a critical situation with rapid progression and high mortality, and timing and approach of intervention for complications are very difficult to handle. PSTN could treat SAP with early appearance of infection or walled-off necrosis, which has advantages of less trauma, higher efficiency, and faster recovery as compared with traditional method and is of valuable in clinical practice.