急性胰腺炎合并结肠瘘的非手术治疗效果分析

Non-surgical treatment of acute pancreatitis with colonic fistula

目的探讨急性胰腺炎合并结肠瘘的非手术治疗效果.方法回顾性分析解放军总医院肝胆外科重症胰腺炎专病中心2013年1月至2018年12月连续收治的354例急性胰腺炎患者的临床资料.其中男性249例,女性105例,年龄(46±14)岁(范围:14-85岁).急性水肿性胰腺炎41例,急性坏死性胰腺炎313例.中重症急性胰腺炎215例,重症急性胰腺炎139例.313例急性坏死性胰腺炎患者中,接受非手术治疗62例,手术治疗251例,其中采用经皮肾镜腹膜后入路胰周坏死组织清除技术218例.结果354例患者中,发生结肠瘘15例,发生率为4.2%,均为急性坏死性胰腺炎患者,其中男性7例,女性8例;年龄(39±8)岁(范围:27-50岁).结肠瘘发生在急性胰腺炎发病后的中位时间为71 d(范围:27-134 d),其中结肠肝曲瘘2例、横结肠瘘4例、结肠脾曲瘘9例.合并横结肠坏死1例,合并降结肠狭窄1例.患者死亡39例,总体病死率为11.0%(39/354).开腹手术治疗2例,其中死亡1例,其余13例患者接受非手术治疗,均痊愈出院.结论急性胰腺炎合并结肠瘘多可采用非手术治疗,可取得较好的治疗效果.

Objective To examine the effectiveness of non-operative of colonic fistula following acute pancreatitis.Methods Retrospective analysis of 354 patients with acute pancreatitis who were admitted to Department of Hepatobiliary Surgery of Chinese People′s Liberation Army General Hospital from January 2013 to December 2018.Age of the patients was(46±14)years(range:14-85 years);249 cases(70.3%)were males.There were 41 cases of acute edematous pancreatitis and 313 cases of acute necrotising pancreatitis.Two hundred and fifteen cases were diagnosed as moderate severe acute pancreatitis and 139 were diagnosed as severe acute pancreatitis.Among 313 cases of acute necrotising pancreatitis,62 cases underwent non-surgical treatment,251 cases underwent surgical treatment in which 218 of minimal access retroperitoneal pancreatic necrosectomy underwent percutaneous nephroliguectomy with peripancreatic necrotic tissue removal technique.Results There were 15 cases of colon fistula following acute necrotising pancreatitis,and the incidence rate was 4.2%(15/354).There were 7 males and 8 females,with age of(39±8)years(range:27 to 50 years).The median interval between acute pancreatitis onset and diagnosis of colonic fistula was 71 days(27-134)days.Two cases occurred at the hepatic flexure of the colon,4 cases at transverse colon,and 9 cases at splenic flexure of colon.Of the 354 patients,39 cases died and the mortality was 11.0%.Two patients underwent laparotomy,and one of them died.The remaining 13 patients underwent non-surgical treatment and were discharged.Conclusion Acute pancreatitis with colonic fistula can be treated with non-surgical treatment and can achieve good prognosis.