单孔腹腔镜腹膜后清创术在感染坏死性胰腺炎治疗中的应用

Single-port laparoscopic retroperitoneal debridement for infectious necrotizing pancreatitis

目的探讨单孔腹腔镜治疗感染坏死性胰腺炎的方法及疗效。方法回顾性分析山东大学齐鲁医院2012年10月至2017年10月收治的63例感染坏死性胰腺炎残余感染期患者的临床资料,其中33例(观察组)实施单孔腹腔镜腹膜后清创引流术。30例(对照组)实施开腹清创引流术。结果观察组患者死亡1例,对照组患者死亡3例。观察组患者的手术时间、术中出血量、住院费用、术后切口感染率、术后住院时间等明显低于对照组,差异有统计学意义(均P<0.05)。两组患者术后结肠瘘、切口疝、胃瘫发生率差异无统计学意义(均P>0.05)。术后患者随访6.0~48.0个月,观察组无新发糖尿病患者,对照组患者新发糖尿病2例,两组差异无统计学意义(P>0.05)。结论单孔腹腔镜腹膜后清创引流术具有创伤小,术后恢复快等优势,且手术操作简便,疗效确切,安全可行,具有良好的应用前景。

Objective To study the feasibility,safety and effectiveness of single-port laparoscopic retroperitoneal debridement for infectious necrotizing pancreatitis.Methods The clinical data of 63 patients with residual infectious stage of infectious necrotizing pancreatitis treated at the Qilu Hospital of Shandong University from October 2012 to August 2017 were retrospectively analyzed.A total of 33 patients who underwent single-port laparoscopic retroperitoneal debridement were classified as the study group,while the remaining 30 patients who underwent traditional open surgery served as the control group.Results One patient in the study group died 20 days after surgery,while three patients in the control group died after surgery.The operation time,intraoperative blood loss,hospitalization cost,surgical site infection rate,postoperative hospital stay and other parameters in the study group were significantly lower than those in the control group(all P<0.05).There were no significant differences in the incidences of postoperative colon fistula,incisional hernia and gastroparesis between the two groups(all P>0.05).After a follow-up which ranged from 6.0 to 48.0 months,there was no newly diagnosed diabetic patients in the study group,but 2 in the control group.The difference was not significantly different(P>0.05).Conclusion Single-port laparoscopic retroperitoneal debridement had the advantages of safety,feasibility and fast postoperative recovery with significant curative effects.