感染性胰腺坏死的外科治疗策略及生存质量评估:附63例回顾性分析

Surgical treatment strategies and quality-of-life assessments for infectious pancreatic necrosis:a retrospective study of 63 cases

目的总结感染性胰腺坏死(infected pancreatic necrosis,IPN)的治疗效果,评估存活病人的生存质量。方法回顾性分析铜川市人民医院肝胆胰脾外科2015年7月至2018年9月收治的63例行有创治疗的IPN病人临床资料,对比分析IPN开腹坏死组织清除术(开腹手术组,33例)与先经皮穿刺置管引流后再行微创入路腹膜后胰腺坏死组织清除术的升阶梯治疗(升阶治疗组,30例)效果和生存质量。结果两组在人口统计学数据、胰腺炎的病因和疾病严重程度方面差异均无统计学意义。全组病人死亡率为12.7%(8/63),其中开腹手术组7例,升阶治疗组1例。病人住院时间差异有统计学意义[(34.9±6.3)d比(25.6±8.7)d,P=0.02)],55例存活病人长期随访,随访时间为(23±9)个月。其中,切口疝(61.5%比24.1%,P=0.01),胰腺外分泌功能不全(46.2%比17.2%,P=0.04),胰腺内分泌功能不全(73.1%比37.9%,P=0.01),脂肪泻(69.2%比27.6%,P<0.05),这些指标升阶治疗组的病人发生率比开腹手术组低。而住院费用、慢性胰腺炎的发生率、腹痛、腹泻及健康调查简表(SF-36)生活质量评分,两组之间差异均无统计学意义(均P>0.05)。结论对于IPN病人,升阶治疗的疗效优于开腹胰腺坏死组织清除术,并且不增加二次手术风险。

Objective To explore the therapeutic effect of infective pancreatic necrotic necrosis(IPN)and to assess the quality-of-life of surviving patients.Methods Clinical data were retrospectively reviewed for 63 IPN patients receiving invasive treatments from July 2015 to September 2018.Comparative analysis the surgical treatment effective and quality-of-life for IPN with open necrosis tissue removal(open necrosectomy group,n=33)and surgical step-up approach that percutaneous puncture and drainage(PCD)followed by mini-invasive pancreatic necrosis tissue removal(step-up treatment group,n=30).Results No significant inter-group differences existed in demographic data,etiology or severity of pancreatitis.The overall mortality was 12.7%(8/63),including open necrosectomy group(n=7)and step-up group(n=1).The duration of hospitalization was(34.9±6.3 vs.25.6±8.7 days,P=0.02)and the difference had statistical significance.After treatments,55 survivors were followed up for(23±9)months.Regarding incisional hernia(61.5%vs.24.1%,P=0.01),pancreatic exocrine insufficiency(46.2%vs.17.2%,P=0.04),pancreatic endocrine insufficiency(73.1%vs.37.9%,P=0.01)and fatty diarrhea(69.2%vs.27.6%,P<0.05),the proportions of patients were lower in step-up group.No significant inter-group difference existed in hospitalization cost,incidence of chronic pancreatitis,abdominal pain,diarrhea or sf-36 quality-of-life score(P>0.05).Conclusion The step-up approach for IPN is superior to open necrosectomy without an elevated risk of reinterventions.