经皮胆道镜及置管引流用于重症急性胰腺炎胰周感染坏死组织清除的临床疗效分析

Clinical Analysis of Debridement and Drainage for Severe Acute Pancreatitis under Choledochoscopy

目的比较经皮胆道镜下清创引流和经皮穿刺置管引流(percutaneous catheter drainage,PCD)治疗重症急性胰腺炎伴有胰周感染的临床疗效。方法回顾性分析2015年4月一2018年2月在北京市航天中心医院入院治疗的65例重症急性胰腺炎伴胰周感染的患者,其中PCD治疗35例(PCD组),经皮胆道镜清创引流治疗30例(胆道镜组)。PCD引流无效时转为胆道镜下清创引流。比较两组患者的治愈率、有效率、并发症发生率(胰瘘、肠瘘、残留脓肿、出血)、术后住院时间和住院费用。结果治愈率,PCD组为51.4%,经皮胆道镜组为93.3%,P<0.05,差异有统计学意义。有效率,PCD组为85.7%,经皮胆道镜组为100%,P>0.05,差异无统计学意义。术后胰瘘为(PCD组5.7%vs经皮胆道镜组3.3%),肠瘘(PCD组5.7%vs经皮胆道镜组3.3%),残留脓肿(PCD组22.9%VS胆道镜组6.6%),均P>0.05,差异无统计学意义。两组患者均无出血发生。术后住院时间和住院费用,PCD组中治愈患者明显少于经皮胆道镜组,但是P>0.05,差异无统计学意义。残留脓肿的8例患者,经胆道镜下治愈,总的住院时间和住院费用略多于胆道镜组。复发率则为PCD组22.86%VS胆道镜组0,胆道镜组优于PTCD组,P<0.05,差异有统计学意义。结论经皮胆道镜下清创引流术治疗重症急性胰腺炎伴胰周感染的治愈率、有效率高,并发生发生率和复发率低,与PCD治疗相比,优势明显,并且操作要求低,无需全麻,适合在基层医院推广。

Objective To compare percutaneous catheter drainage(PCD) and debridement and draining under percutaneous choledochoscopy clinical efficacy in patients with severe acute pancreatitis (SAP) with peripancreatic infection. Methods Retrospective analysis of April 2015 to February 2018 in our department treated 65 cases of severe acute pancreatitis(SAP) with peripancreatic infection,the patients were divided into PCD group 35 cases and percutaneous choledochoscopy group 30 cases.If no significant improvemen after PCD,the cases were conversed to debridement and draining under percutaneous choledochoscopy.Comparative the two groups’ cure rate,the efficiency,complication rate (pancreatic fistula,intestinal fistula,residual abscess after operation,hemorrhage),the hospitalization time,hospitalization expenses after operation and recurrence rate.Results PCD group cure rate was 51.4%,percutaneous choledochoscopy group was 93.3%,P<0.05,the difference was statistically significant.the efficiency was 85.7%(PTCD group) VS 100%(percutaneous choledochoscopy group),there was not significant difference between two groups ( P>0.05);PCD group VS percutaneous choledochoscopy group:pancreatic fistula(5.7% vs 3.3%,P > 0.05);intestinal fistula (5.7% vs 3.3%,P > 0.05),residual abscess rate(22.9% vs 6.6%,P > 0.05),the difference was not statistically significant. The two group were no hemorrhage.Crued cases of PCD group,the hospital stay and hospitalization expenses after operation were less to percutaneous choledochoscopy group,but 8 cases of residual abscess,which were underwent subsequently debridement and draining under percutaneous choledochoscopy,were more than percutaneous choledochoscopy group,but P > 0.05,th e difference was not statistically significant.Recurrence rate,PCD group were 22.86%,percutaneous choledochoscopy group were 0,P < 0.05,the difference was statistically significant.Conclusion The way about debridement and draining of peripancreatic infection with SAP has a high cure rate and the efficiency,and its complication rate and recurrence rate were low,which was significantly better than PCD.The operation is easy,and no general anesthesia,so it is suitable for development in the primary hospital.