重症急性胰腺炎并发机械性结肠梗阻的微创化个体化外科治疗-单中心12例经验总结

Minimally invasive individualized surgical treatment of severe acute pancreatitis complicated by mechanical colon obstruction:a summary of experience in 12cases from a single center

目的探讨重症急性胰腺炎并发机械性结肠梗阻的外科治疗策略选择.方法回顾性分析天津市南开医院肝胆胰外科一于2020年9月至2022年9月期间收治的12例重症急性胰腺炎并发机械性结肠梗阻,接受肠梗阻导管减压后行微创个体化外科治疗策略患者的临床资料.结果12例患者均为重症急性坏死性胰腺炎,胰腺炎发病到出现结肠梗阻的中位时间为60.5天(20.5,108).梗阻位于脾区9例(75.0%).12例接受肠梗阻导管治疗,经鼻导管6例,经肛导管6例.11例接受了PCD穿刺引流,单纯PCD治愈者3例,8例在PCD基础上进行多次的MARPN.肠梗阻症状24小时内基本缓解;梗阻持续时间为3~40天,梗阻中位解除时间为20天(13.25,23.5).并发肠瘘2例(16.6%),1例出血,反复梗阻1例,全部患者治愈.结论采取肠梗阻导管联合程序化个体化微创外科治疗体系治疗急性重症胰腺炎并发机械性结肠梗阻是一种安全、有效的策略,可减少开腹手术、肠切除、肠造瘘可能,降低相关并发症,改善患者的愈后.

Objective To investigate the surgical treatment strategy options for acute severe pancreatitis complicated by me-chanical colon obstruction.Methods The clinical data of 12 patients with SAP complicated by mechanical colon obstruction whound-erwent Minimally invasive individualized surgical treatment strategies and Ileus Tube were retrospectively analyzed in the Department of Hepatobiliary andPancreatic Surgery,Nankai Hospital,Tianjin from September 2020 to September 2022.Result All 12 patients were diagnosed with acute severe necrotizing pancreatitis(SAP).The median time from the onset of pancreatitis to the occurrence of colon obstruction was 60.5 days(20.5,108).The obstruction was located in the splenic area in 9 cases(75%).Twelve patients received Ileus Tube,6 patients with transnasal catheters and 6 patients with transanal catheters.11 patients received PCD,3 patients were cured of PCD alone,and 8 patients underwent multiple MARPN on the basis of PCD.Symptoms of intestinal obstruction are basically relieved within 24 hours;the duration of obstruction ranges from 3 to 40 days,and the median time to relieve obstruction is 20 days(13.25,23.5).Postoperative complications occurred in 2 cases(16.66%)of intestinal fistula,1 case of bleeding,and 1 case of recurrent ob-struction.All patients were cured.Conclusion Ileus Tuber associated with a programmed individualized minimally invasive surgical treatment system to treat acute severe pancreatitis complicated by mechanical colon obstruction is a safe and effective strategy.It can re-duce the occurrence of intestinal resection,enterostomy and related complications,while improve the prognosis of patients.