腹腔镜经胃胰腺坏死组织清除治疗包裹性胰腺坏死32例疗效分析

Laparoscopic transgastric debridement for walled-off pancreatic necrosis:An analysis of 32 cases

目的探讨腹腔镜经胃胰腺坏死组织清除(LTGD)治疗包裹性胰腺坏死(WOPN)的安全性及有效性。方法回顾性分析2011年1月至2020年12月在首都医科大学宣武医院接受LTGD治疗的32例病人资料。记录手术时间、术后住院时间、围手术期及远期并发症发生情况。结果32例WOPN病人中,28例(87.5%)局限于胰腺或胰周,23例(71.9%)合并脾静脉血栓及左侧门静脉高压。手术时距离发病45(27~181)d。手术时间(151±32)min,出血量(75±40)mL,术后住院时间12(6~43)d,术后并发症发生率为21.9%(7/32),Clavien-DindoⅢ级及以上并发症发生率为15.6%,死亡率为3.13%。中位随访时间52(6~101)个月,27例(84.4%)病人成功获得随访,所有WOPN均吸收,无复发。随访期内,胰腺内、外分泌功能障碍发生率分别为18.5%(5/27)及14.8%(4/27)。结论对局限于胰腺或胰周的WOPN,LTGD是安全、有效的治疗方式。

Objective To investigate the safety and efficacy of laparoscopic transgastric debridement(LTGD)in the treatment of walled-off pancreatic necrosis(WOPN).Methods The data of 32 patients who underwent LTGD in Xuanwu Hospital,Capital Medical University from January 2011 to December 2020 was analyzed retrospectively.The operation time,postoperative hospital stay,perioperative and long-term complications were recorded.Results Among the 32 patients,28 cases(87.5%)were confined to the pancreas or peripancreatic region.A total of 23 cases(71.9%)were complicated with splenic vein thrombosis and left portal hypertension.At the time of operation,it was 45(27 to 181)days from the onset of the disease.The average operation time was(151±32)min with estimated blood loss(75±40)mL.The postoperative hospital stay was 12(6 to 43)d.The incidence of postoperative complications was 21.9%(7/32)with Clavien-Dindo gradeⅢand above complications 15.6%,and the mortality was 3.13%.The median follow-up time was 52(6 to 101)months.Twenty-seven patients(84.4%)were followed up successfully.All WOPN were absorbed without recurrence.During the follow-up period,the incidences of pancreatic endocrine and exocrine dysfunction were 18.5%(5/27)and 14.8%(4/27),respectively.Conclusion LTGD is safe and effective for WOPN confined to pancreas or peripancreatic region.