经腹腔前入路穿刺导管引导下腹腔镜手术在感染坏死性胰腺炎中的应用

Transperitoneal approach guided by puncture catheter on laparoscopic treatment of infectious necrotizing pancreatitis

目的探讨经腹腔前入路穿刺导管引导下腹腔镜手术治疗感染坏死性胰腺炎的方法及疗效。方法回顾性分析2018年6月至2021年3月在浙江大学医学院附属金华医院行经腹腔前入路穿刺导管引导下腹腔镜手术清除胰腺坏死组织的7例感染坏死性胰腺炎患者的临床资料。7例患者中男性3例,女性4例,年龄(49.6±9.4)岁,年龄范围32~65岁。收集患者一般资料、手术时间、术中出血量等临床资料。术后1周复查肝胆胰CT,观察囊腔大小变化、双套管位置及坏死组织清除效果。结果7例患者术前均在B超定位下行感染性坏死病灶穿刺引流术,发病至经腹腔前入路穿刺导管引导下腹腔镜手术前病程为42~58 d。所有患者均顺利完成手术,其中5例同时行胆囊切除术,无中转开腹。手术时间140~195 min,术中出血量30~100 ml,术后住院时间28~42 d,术后肛门排气时间2~4 d。术后1周常规复查肝胆胰CT,发现与术前相比,胰腺坏死感染明显好转,囊腔缩小。有1例患者术后出现腹腔出血,无其他严重并发症发生。术后随访6~12个月,所有患者均恢复良好。结论经腹腔前入路穿刺导管引导下腹腔镜手术治疗感染坏死性胰腺炎安全可行,具有创伤小、恢复快等优点,尤其适合胆源性胰腺炎。

ObjectiveTo study the feasibility,safety and efficacy using transperitoneal approach guided by puncture catheter on laparoscopic treatment of infectious necrotizing pancreatitis.MethodsThe clinical data of 7 patients who underwent laparoscopic treatment of infectious necrotizing pancreatitis using the transperitoneal approach at Jin Hua Jinhua Hospital of Zhe Jiang Zhejiang University from June 2018 to March 2021 were retrospectively analyzed.There were 3 males and 4 females,with age of(49.6±9.4)years old(range 32-65 years old).The general data,operation time,intraoperative blood loss and other clinical data were collected.Hepatobiliary and pancreatic CT was reviewed 1 week after the operation to study the changes in size of lesion,double cannula position and effect of necrotic tissue removal.ResultsAll patients were treated with percutaneous puncture and drainage under ultrasonic guidance before surgery.The course of the disease before operation was 42-58 days.All patients successfully completed surgery,and 5 patients underwent cholecystectomy.No patients required conversion to open surgery.The operation time was 140-195 min,the intraoperative blood loss was 30-100 ml,the postoperative hospital stay was 28-42 days,the postoperative time to first passed flatus was 2-4 days.Routine hepatobiliary and pancreatic CT 1 week after the operation showed that the degrees of necrosis and infection of pancreas were significantly improved and the lesion cavity was reduced compared with those before the operation.One patient suffered from abdominal hemorrhage after operation.There were no other serious complications.All patients recovered well after 6 to 12 months follow-up.ConclusionLaparoscopic treatment of infectious necrotizing pancreatitis by using the transperitoneal approach guided by puncture catheter was safe and feasible.The treatment had the advantages of less trauma and fast recovery,and it was especially suitable for patients with biliary pancreatitis.