经皮肾镜引流技术在感染坏死性胰腺炎患者中的应用

Application of percutaneous nephroscope drainage in patients with infected necrotizing pancreatitis

目的:探讨经皮肾镜引流治疗重症急性胰腺炎感染性坏死的手术时机、方法及疗效。方法:选取2016年1月-2019年3月实施经皮肾镜下坏死组织清除及引流术的重症急性胰腺炎合并感染患者4例,术前通过CT明确感染病灶,在肾镜下清除部分坏死组织,生理盐水冲洗感染灶,病灶区放置多根腹腔引流管,术后7~10 d冲洗引流,如坏死组织较多,术后半个月再次经皮肾镜清除坏死组织并冲洗引流。结果:4例患者确诊距手术干预时间平均26 d,所有手术在肾镜下完成,期间无中转开腹;平均手术时间140 min,术中平均出血量100 mL;术后胰瘘1例,假性囊肿1例,无死亡病例,无腹腔内出血;术后平均住院时间82 d。结论:对重症急性胰腺炎感染性坏死患者,采用经皮肾镜下行胰周感染病灶清创引流术是安全、有效的。

Objective:To explore the operative timing,methods and efficacy of percutaneous nephroscope drainage in the treatment of patients with severe acute infected necrotizing pancreatitis.Methods:From January 2016 to March 2019,4 patients with severe acute pancreatitis complicated with infection who performed percutaneous nephroscope necrosis tissue removal and drainage were selected.Before operation,the infected lesions were identified by CT and some necrotic tissues were removed under nephroscopy,normal saline was used to wash the infected foci,multiple abdominal drainage tubes were placed in the focal area,flushing and drainage were performed 7 to 10 days after surgery,if there was more necrotic tissue,the necrotic tissue was removed and flushed and drained again by percutaneous nephroscope half a month after surgery.Results:In 4 patients,from diagnosis time to surgical intervention time was an average time of 26 days,all operations were completed under nephroscope and there was no conversion to open surgery during this period.The average operative time was 140 min,the average intraoperative bleeding volume was 100 mL.One case of postoperative pancreatic fistula and one case of pseudocyst.No deaths,no intraperitoneal bleeding.Average postoperative hospitalization time was 82 d.Conclusion:It is safe and effective for patients with severe pancreatitis with infective necrosis to perform debridement and drainage of peripancreatic infection by percutaneous nephroscopy.