重症急性胰腺炎后胰腺脓肿引流方法的比较

The drainage of pancreatic abscess complicated with severe acutem0 pancreatitis

目的 总结重症急性胰腺炎后胰腺脓肿的治疗经验 ,将脓肿加以分型 ,并就其引流方法与疗效的关系进行比较 ,以指导临床工作。方法 收集本院近20年共48例胰腺脓肿病例 ,根据胰腺脓肿的大小、位置和形状分成三型 ,采用剖腹引流、经皮穿刺引流、低位小切口不经腹引流和F管引流四种方法。结果 剖腹引流25例 ,其中8例需再次手术 ,3例经三次手术治愈 ,因大出血、肠瘘等并发症死亡4例 ;经皮穿刺引流8例 ,4例治愈 ,4例中转开腹后治愈 ;经后腰低位小切口不经腹引流10例 ,均获痊愈。F管引流5例 ,治愈3例。结论 重症胰腺炎后胰腺脓肿引流方法的选择与治疗效果直接相关 。

Objective To sum up the therapeutic experience for pancreatic abscess complicated with severe acute pancreatitis (SAP) and to compared the methods of drainage according to its classification, so as to guide the clinical work. Methods 48 patients with pancreatic abscess were retrospectively analysed , pancreatic abscess were divided into 3 groups according to its size, location and figure. Four methods of drainage were adopted,including open operation drainage, percutaneous puncture drainage, small incision drainage at lower location but not into peritoneal cavity and 'F'tube drainage. Results 25 cases drainaged by open operation, among them 8 adopted second look operation and 3 cases third look operation, 4 died of the severious complications such as overwelming blooding and intestinal fistula 8 cases through percutaneous puncture drainage, 4 cases cured and the rest converting to open operation and then cured; 10 cases by small incision through lower location but not into peritoneal cavity, all cured. Conclusion The effects of drainage related directly to the choose of methods of drainage for pancreatic abscess complicated with SAP, abscess classification and appropriate approach will benefit clincial work.