后腹腔镜治疗重症急性胰腺炎合并感染性胰腺坏死:附20例报道

Retrolaparoscopy in treatment of severe acute pancreatitis complicated with infected pancreatic necrosis:report of 20 cases

目的探索后腹腔镜治疗重症急性胰腺炎合并感染性胰腺坏死的安全性和可行性。方法回顾性收集2017年5月至2022年5月期间于笔者所在医院接受后腹腔镜治疗的20例重症急性胰腺炎合并感染性胰腺坏死患者的临床资料。结果20例患者中,18例患者一期行经皮穿刺引流(percutaneous catheter drainage,PCD),1例妊娠合并重症急性胰腺炎患者一期行开腹手术引流,1例患者一期在外院行开腹手术引流。所有患者均成功实施后腹腔镜清创引流,手术时间68~106 min、(89.8±11.7)min;术中出血量100~300 mL、(171.3±61.0)mL;住院时间28~62 d,中位数为48 d。术后患者全身中毒症状均迅速缓解。1例患者行2次后腹腔镜清创手术,其余患者仅行1次后腹腔镜清创引流。术后17例患者无并发症发生,1例患者术后并发结肠瘘,2例患者发生腹腔出血。术后20例患者均获访,随访时间6~62个月,中位数为31个月。随访期间患者症状完全消失,均无复发。结论经后腹腔镜途径治疗重症急性胰腺炎并感染性胰腺坏死安全有效、并发症少。

Objective To explore the safety and feasibility of retrolaparoscopy in treatment of severe acute pancreatitis complicated with infected pancreatic necrosis.Methods Clinical data of 20 patients with severe acute pancreatitis complicated with infectious pancreatic necrosis who received retrolaparoscopy treatment in our hospital from May 2017 to May 2022 were retrospectively collected.Results Among the 20 patients,18 patients underwent percutaneous catheter drainage,1 pregnant patient with severe acute pancreatitis underwent laparotomy drainage in the first phase,and 1 patient underwent laparotomy drainage in the first phase from another hospital.All patients underwent successful retroperitoneal drainage,microscopic debridement and drainage were performed.The operation time was 68–106 minutes,(89.8±11.7)minutes;intraoperative bleeding was 100–300 mL,(171.3±61.0)mL;hospitalization was 28–62 d,with median time of 48 d.After the operation,the systemic poisoning symptoms of the patients were quickly relieved.One patient underwent twice retroperitoneoscopic debridement surgeries,and the remaining patients underwent only once retroperitoneoscopic debridement drainage surgery.There were no complications in 17 patients,but 1 patient was complicated by colonic fistula after surgery,2 patients suffered from abdominal bleeding.After the operation,20 patients were interviewed,and the follow-up time was 6–62 months,with the median of 31 months.During postoperative follow-up period,the patients’symptoms completely disappeared and there was no recurrence.Conclusion The retrolaparoscopic approach in treatment of severe acute pancreatitis complicated with infected pancreatic necrosis is safe and effective,and has few complications.