感染性胰腺坏死的区域动脉灌注治疗

Treatment of infected pancreatic necrosis with regional intra-arterial infusion.

目的 探讨早期区域动脉灌注治疗感染性胰腺坏死(infected pancreatic necrosis,IPN)的可行性及疗效。方法 1999年8月以来采用早期区域动脉灌注治疗12例IPN病人,其疗效与1995年6月以来采用传统手术方法治疗的22例IPN病人进行比较。结果 手术组的死亡率为36.4％、并发症发生率为72.7％、二(多)次手术率为22.7％、住院时间为(43.0±12.0)d、住院费用为(8.77±3.74)万元,而早期区域动脉灌注组的死亡率为8.3％(P<0.01)、并发症发生率为27.2％(P<0.05)、中转手术率为16.7％(P>0.05)、住院时间为(27.1±4.7)d(P<0.01)、住院费用为(4.09±1.46)万元(P<0.01)。结论 在IPN的早期可采用区域动脉灌注治疗;在区域动脉灌注治疗过程中出现感染病灶局限化或形成胰腺、胰周脓肿时可中转手术治疗;对于胰周渗出量较多、病情特别严重的病例在行区域动脉灌注治疗的同时可联合早期简化手术引流。

Objective To study the feasibility and therapeutic efficacy of regional intra-arterial infusion (RIAI) in treatment of infected pancreatic necrosis (IPN). Methods The clinical data of 12 patients with IPN treated with RIAI in our hospital after August 1999 (group A) were compared with those of other 22 patients treated with routine surgical methods after June 1995 (group B). Results The mortality, incidence of complications , duration of hospitalization and fee-for-service were significantly higher in group B than in group A (36. 4% vs 8. 3%, 72. 7% vs 33. 3%, 43. 0±12. 0 d vs 27. 1 ± 4. 7 d, (8. 77 ±3. 74) ( 1000 yuan vs (4. 09 ± 1. 64) ( 1000 yuan, P<0. 01 and 0. 05). Conclusions It is feasible to employ RIAI for treatment of IPN in the early stage. During RIAI, operation might be performed in case that the infectious foci are localized or the pancreatic abscess or peri-pancreatic abscess forms. In those patients with very serious illness and excessive peri-pancreatic effusion, RIAI in combination with early simplified operation for drainage should be performed.