视频辅助小切口手术治疗感染性胰腺坏死的临床研究

Video assisted small incision in treatment of infected pancreatic necrosis

目的探讨视频辅助小切口手术治疗感染性胰腺坏死(IPN)的临床疗效。方法回顾性分析2018年1月至2019年12月湖南省人民医院胰脾外科行视频辅助小切口手术治疗的27例IPN患者的临床资料。记录患者的手术入路方式、手术时间、术中出血量、术后住院时间及并发症发生情况。采用门诊复查方式进行术后随访,记录患者术后完全恢复时间及远期并发症。结果27例IPN患者中男性22例,女性5例,年龄为(50.6±6.2)岁,均顺利完成视频辅助小切口手术,经腹膜后入路4例,经网膜囊入路14例,经肋间隙入路2例,联合入路7例。手术时间为(85.3±31.6)min,术中出血量为65.0(45.2,121.4)ml。术后住院时间为23.0(12.5,36.1)d。全组并发症(Clavien-DindoⅢ级及以上)发生率为14.8%(4/27)。其中2例患者因术后出血入重症病房,1例经保守治疗愈合,1例经介入治疗愈合;1例因为效果差,于术后2周行开腹手术再次清创痊愈;1例并发C级胰瘘,6个月后经手术治疗痊愈。随访期间有2例患者在术后2周发生结肠瘘,2例分别在术后1和3周发生胃瘘,均经保守治疗痊愈。结论选择合适的病例,采用视频辅助小切口手术能有效清除胰腺坏死组织,安全有效。

Objective To study the indications and clinical efficacy of video assisted small incision in treatment of infected pancreatic necrosis.Methods A retrospective study was conducted on 27 patients with infected pancreatic necrosis treated by video assisted small incision at the Department of Pancreatic and Splenic Surgery,Hunan Provincial People's Hospital,from January 2018 to December 2019.The surgical approach,operation time,intraoperative blood loss,postoperative hospital stay and complications were analysed.Postoperative follow-up was carried out at outpatients’clinic,and the patient's time to full recovery and long-term complications were studied.Results The 27 patients successfully underwent the operations.There were 22 males and 5 females,aged(50.6±6.2)years.The treatment results were analyzed according to the different surgical approaches:the retroperitoneal approach group(n=4);the omental sac approach group(n=14);the intercostal space approach group(n=2);and the combined approach group(n=7).The operation time was(85.3±31.6)min.The intraoperative blood loss was 65.0(45.2,121.4)ml.The postoperative hospital stay was 23.0(12.5,36.1)days.The incidence of complications(Clavien-Dindo grade Ⅲ and above)was 14.8%(4/27).There were 2 patients in this study who were admitted to the intensive care unit due to postoperative hemorrhage:1 patient responded well to conservative treatment and the remaining patient required interventional treatment.Another patient because of poor results,underwent debridement by laparotomy 2 weeks after the operation.There was 1 patient who developed grade C pancreatic fistula which was cured by surgical treatment 6 months later.On follow-up,2 patients developed colonic fistula 2 weeks after surgery and 2 patients gastric fistula 1 week and 3 weeks after surgery.These patients responded to conservative treatment.Conclusion With proper case selection,video assisted small incision could safely and effectively be used to treat infected pancreatic necrosis.