改良的开腹手术与小切口联合肾镜手术在"一步法"治疗胰腺坏死组织感染中的应用

Application of modified open necrosectomy and small incision combined with nephroscopic operation in"one-step"treatment for infected pancreatic necrosis

目的评估改良的开腹手术(MON)和小切口联合肾镜手术(SINO)在"一步法"治疗胰腺坏死组织感染(IPN)中的疗效。方法回顾性分析2012年12月至2022年12月在湖南省人民医院接受"一步法"手术治疗的28例IPN患者的临床资料,其中男性17例,女性11例,年龄(53.2±13.0)岁。收集患者的一般资料、胰腺炎特征等临床资料。比较患者术前和术后第7天白细胞计数、中性粒细胞计数、血细胞比容、C-反应蛋白等实验室指标。以门诊复查和电话提问的方式进行随访。结果接受"一步法"治疗的28例IPN患者中,采用MON治疗的患者16例,采用SINO治疗的患者12例,28例患者均顺利完成"一步法"手术治疗。与手术治疗前相比,28例患者术后的白细胞计数[9.6(6.7,12.6)×10^(9)/L比12.7(8.2,16.6)×10^(9)/L]和C-反应蛋白[48.0(25.5,86.4)mg/L比60.0(23.6,86.8)mg/L]均降低,差异具有统计学意义(均P<0.05)。16例采用MON治疗的患者术后可耐受脂餐者3例、可生活自理者9例、可胜任工作者9例。12例采用SINO治疗的患者术后可耐受脂餐者3例、可生活自理者6例、可胜任工作者3例。28例患者总死亡率为10.7%(3/28)。28例患者均未发生切口疝,采用MON治疗的患者无严重并发症发生,采用SINO治疗的患者新发器官功能衰竭1例、需干预的出血2例、新发空腔脏器穿孔或胃肠瘘4例。结论针对有"一步法"治疗指征的IPN患者,MON和SINO两种术式均安全有效。

Objective To evaluate the efficacy of modified open necrosectomy(MON)and small incision combined with nephroscopic operation(SINO)in the"one-step"treatment for infected pancreatic necrosis(IPN).Methods The clinical data of 28 patients with IPN undergoing"one-step"surgery in Hunan Provincial People's Hospital from December 2012 to December 2022 were retrospectively analyzed,including 17 males and 11 females,aged(53.2±13.0)years old.The general information,characteristics of pancreatitis and other clinical data of patients were collected.The white blood cell count,neutrophil count,hematocrit,C-reactive protein(CRP)and other laboratory indicators were compared before and 7 days after surgery.Patients were followed up by outpatient or telephone review.Results Among the patients,16 were treated with MON and 12 with SINO.All procedures were successfully completed.Compared to preoperative data,white blood cell count[9.6(6.7,12.6)×10^(9)/L vs.12.7(8.2,16.6)×10^(9)/L]and CRP 48.0(25.5,86.4)mg/L vs.60.0(23.6,86.8)mg/L]decreased after surgery(both P<0.05).In MON group,three patients could tolerate fat diet,nine restored physical self-maintenance,and nine returned to occupation after surgery.In SINO group,three patients could tolerate fat diet,six restored physical self-maintenance,and three returned to occupation after surgery.The mortality of 28 patients was 10.7%(3/28).None of patients had incisional hernia.No major complications occurred in MON group.In SINO group,one patient developed new organ failure,two suffered postoperative bleeding requiring intervention,and four suffered new hollow visceral perforation or gastrointestinal fistula.Conclusion Both MON and SINO are safe and feasible for one-step treatment in patients with IPN.