超声碎石系统辅助经皮肾镜腹膜后胰腺坏死清除术的临床应用分析

Application of the ultrasonic lithotripsy system in assisting nephroscopic retroperitoneal debridement in pancreatic necrosectomy

目的探讨超声碎石系统(ULS)辅助经皮肾镜腹膜后胰腺坏死清除术在两侧型急性坏死性胰腺炎(ANP)患者中的安全性和疗效。方法回顾性分析2017年1月至2022年10月在浙江大学医学院附属杭州市第一人民医院行视频辅助经皮肾镜腹膜后清创术(VARD)的47例两侧型ANP患者的临床资料,其中男性32例,女性15例,年龄60(43,75)岁。按清创手术方式分为两组:采用标准肾镜胰腺坏死清除术(NPN)的患者为NPN组(n=22);采用ULS辅助肾镜胰腺坏死清除术的患者为ULS组(n=25)。比较两组患者的手术清创次数、手术时间、并发症等指标。以电话、门诊和(或)住院的方式定期随访患者的复发及死亡情况。结果所有患者均成功进行VARD,无中转开腹病例,无术后转重症监护室及手术相关死亡病例。两组患者术后胰腺外分泌功能均未受损。与ULS组相比,NPN组清创次数更多[3(2,4)次/人比2(1,2)次/人],手术时间[65(40,85)min比35(30,50)min]和住院时间[91(76,130)d比72(62,102)d]也更长,差异均具有统计学意义(均P<0.05)。ULS组患者术后均未发生并发症;NPN组术后发生出血3例,结肠瘘1例,迟发型病毒性脑炎1例。NPN组术后并发症发生率高于ULS组[22.7%(5/22)比0(0/25)],差异具有统计学意义(P=0.032)。47例两侧型ANP患者全部获得随访,中位随访时间28个月,随访时间范围3~60个月。截至随访结束,无残余复发及死亡病例。结论对于两侧型ANP患者,ULS辅助肾镜胰腺坏死清除术安全可行,且与NPN相比,ULS辅助肾镜胰腺坏死清除术在清创效率、手术时间和住院时间上更具优势。

Objective To study the safety and efficacy of using the ultrasonic lithotripsy system(ULS)in assisting percutaneous nephroscopic retroperitoneal pancreatic necrosectomy in patients with acute necrotizing pancreatitis(ANP)extending to both sides of the retroperitoneal regions.Methods The clinical data of 47 patients with extensive ANP who underwent video-assisted retroperitoneal debridement(VARD)from January 2017 to October 2022 at the Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine,were analyzed retrospectively.There were 32 males and 15 females,aged[M(Q1,Q3)]60(43,75)years old.The patients were divided into two groups based on the debridement methods:patients treated by nephroscopic pancreatic necrosectomy(NPN)were included in the NPN group(n=22),while patients treated by the ULS-assisted treatment were included in the ULS group(n=25).The surgical debridement time,operation time and complications of the two groups were compared.Follow up on recurrence and death of patients was done by telephone,outpatient and/or re-hospitalization records.Results All patients underwent the VARD operation successfully,without any need for conversion to laparotomy,transfer to intensive care unit and death related to the operations.The pancreatic exocrine function was not damaged in both groups.When compared with the ULS group,the NPN group required significantly more debridement time[3(2,4)times/person vs.2(1,2)times/person],longer operation time[65(40,85)min vs.35(30,50)min]and longer hospitalization time[91(76,130)d vs.72(62,102)d,all P<0.05].No complications occurred in the ULS group.In the NPN group,postoperative hemorrhage occurred in 3 patients,colon fistula in 1 patient,and delayed viral encephalitis in 1 patient.The incidence of postoperative complications in the NPN group was significantly higher than that in the ULS group[22.7%(5/22)vs.0(0/25),P=0.032].All the 47 patients with extensive ANP were followed up for a median of 28 months(range 3 to 60 months),and there were no patients who developed residual recurrence and death.Conclusion For patients with extensive ANP,ULS-assisted nephroscopic pancreatic necrosectomy was safe and feasible.When compared with NPN,the ULS-assisted procedure showed more advantages in debridement efficiency,operation time and hospital stay.