超声引导经皮腹膜后穿刺引流治疗重症急性胰腺炎并发感染性胰腺坏死

Clinical efficacy of ultrasound-guided percutaneous retroperitoneal drainage in the treatment of severe acute pancreatitis complicated with infected peripancreatic necrosis

目的探讨超声引导经皮腹膜后穿刺引流治疗重症急性胰腺炎(SAP)并发感染性胰腺坏死(IPN)的有效性和安全性。方法回顾性分析2021年2月至2024年2月期间浙江大学医学院附属金华医院SAP并发IPN行超声引导经皮腹膜后穿刺引流治疗的53例患者临床资料,阐述SAP并发IPN的穿刺时机、穿刺路径,并对引流效果进行分析及经验总结。结果53例行超声引导下穿刺的患者中,联合CT辅助下引导穿刺12例;平均于病程28.3(5~41)d时进行穿刺,穿刺路径包括经胃结肠韧带35例次、经脾肾间隙13例次、经肾下极12例次、经脾胃间隙9例次和经肝肾间隙9例次。32例患者引流效果佳,总有效率60.4%;余21例需升阶梯干预。发生穿刺并发症5例,包括3例蜂窝织炎、1例腹腔出血(脾门区)、1例肠管损伤(结肠脾区),经综合介入和手术治疗后好转。结论超声引导经皮腹膜后穿刺引流治疗SAP并发IPN是安全可行的,可有效地应用于SAP升阶梯治疗的首要环节,部分疑难穿刺路径需多种影像学引导。

Objective To investigate the efficacy and safety of ultrasound-guided percutaneous retroperitoneal drainage in the treatment of severe acute pancreatitis(SAP)complicated with infected peripancreatic necrosis(IPN).Methods The clinical data of 53 patients with SAP and IPN,who underwent ultrasound-guided percutaneous retroperitoneal drainage in Jinhua Hospital between Feb.2021 and Feb.2024,were retrospectively analyzed.The puncture timing and puncture path selection of SAP complicated with IPN were elaborated,and the drainage effect was analyzed and the experience was summarized.Results Among 53 patients,12 patients received additonal CT assisted puncture.Puncture was performed at 28.3(5-41)d of the disease course.The puncture paths included 35 times of transgastric colonic ligament,13 times of trans spleno-renal space,12 times of trans inferior pole of kidney,9 times of trans splengastric space and 9 times of trans hepato-renal space.The total effective rate was 60.4%(32/53),and the remaining 21 patients needed step-up intervention.Puncture complications occurred in 5 cases,including 3 cases of cellulitis,1 case of intraperitoneal hemorrhage(splenic hilum area),and 1 case of intestinal injury(colon splenic area),which improved after comprehensive intervention and surgical treatment.Conclusion Ultrasound-guided percutaneous retroperitoneal drainage for the treatment of SAP complicated with IPN is safe and feasible,and can be effectively applied to the first step of the ascending ladder treatment for SAP,and some difficult puncture paths require multiple imaging guidance.