分期阶梯微创手术治疗重症急性胰腺炎的疗效

Efficacy of Minimally Invasive Staging Surgery in Treatment of Severe Acute Pancreatitis

目的分析分期阶梯微创手术治疗重症急性胰腺炎(SAP)的疗效。方法回顾性分析2001年1月至2019年10月火箭军特色医学中心收治的105例SAP患者的临床资料,按照手术方式不同分为对照组(39例)和观察组(66例)。其中,对照组采用剖腹手术,观察组采用分期阶梯微创手术。比较两组的手术及住院情况、检验指标(血淀粉酶、血脂肪酶、C反应蛋白)和肠道功能恢复时间,以及死亡和手术并发症发生情况。结果观察组的手术次数多于对照组[(2.79±0.37)次比(1.38±0.21)次](t=21.788,P<0.001),手术时间和住院时间短于对照组[(68±24)min/次比(137±32)min/次,(53±12)d比(111±19)d](t=12.370,t=18.736,均P<0.001)。观察组血淀粉酶、血脂肪酶、C反应蛋白恢复正常水平时间及肠道功能恢复时间均短于对照组[(16.8±5.2)d比(27.6±6.8)d,(32.9±8.2)d比(43.6±6.7)d,(36.8±5.9)d比(51.9±7.6)d,(6.9±2.9)d比(9.4±3.7)d](均P<0.01)。观察组的病死率低于对照组[0比15.4%(6/39)](P<0.01)。观察组出血、肠瘘、多器官功能衰竭、全身感染的近期并发症发生率低于对照组(P<0.01),胰腺假性囊肿发生率高于对照组(P<0.05)。观察组慢性胰腺炎、糖尿病的远期并发症发生率低于对照组(P<0.01)。结论在SAP个体化治疗中,与剖腹手术相比,分期阶梯微创手术虽然增加了手术次数及近期并发症,但在疗效及社会效益方面具有明显优势。

Objective To analyze the efficacy of minimally invasive staging surgery in the treatment of severe acute pancreatitis(SAP).Methods A retrospective case-control study was conducted and total of 105 patients with SAP in PLA Rocket Force Characteristic Medical Center from Jan.2001 to Oct.2019 were enrolled in this study.The cases were divided into a control group(39 cases)and an observation group(66 cases)according to different operation methods.Laparotomy was performed in the control group,while the observation group was treated with minimally invasive staging surgery.The operation and hospitalization situation,test indexes(blood amylase,blood lipase,C-reactive protein),recovery time of intestinal function,death and surgical complications were compared between the two groups.Results The number of operations in the observation group was more than that in the control group[(2.79±0.37)times vs(1.38±0.21)times](t=21.788,P<0.001),the operation time and hospital stays were shorter than those in the control group[(68±24)min/time vs(137±32)min/time,(53±12)d vs(111±19)d](t=12.370,t=18.736,all P<0.001).The recovery time of serum amylase,serum lipase,C-reactive protein and intestinal function in the observation group were shorter than those in the control group[(16.8±5.2)d vs(27.6±6.8)d,(32.9±8.2)d vs(43.6±6.7)d,(36.8±5.9)d vs(51.9±7.6)d,(6.9±2.9)d vs(9.4±3.7)d](all P<0.01).The fatality rate of the observation group was lower than that of the control group[0 vs 15.4%(6/39)](P<0.01).The incidence of bleeding,intestinal fistula,multiple organ failure and systemic infection in the observation group was lower than those in the control group(P<0.01),and the incidence of pancreatic pseudocyst was higher than that in the control group(P<0.05).The incidence of long-term complications such as chronic pancreatitis,diabetes in the observation group was lower than that in the control group(P<0.01).Conclusion In individualized treatment of SAP,compared with laparotomy,minimally invasive staging surgery has obvious advantages in curative effect and social benefits,although it increases the number of operations and recent complications.