经腹多通道引流联合微创清创治疗急性坏死性胰腺炎临床研究

Clinical efficacy of intraperitoneal multi- channel puncture and drainage combined with debridement of minimally invasive necrotic tissue in treatment of acute necrotizing pancreatitis

目的评价经腹腔多通道穿刺引流联合后期微创坏死组织清创治疗急性坏死性胰腺炎的临床效果,为临床治疗急性坏死性胰腺炎提供指导依据。方法将桂林医学院第二附属医院肝胆胰外科2016年1月至2017年12月收治的急性坏死性胰腺炎130例患者随机分为A组(63例)和B组(67例),A组进行经腹腔多通道穿刺引流术治疗,B组患者采用经腹腔多通道穿刺引流联合后期微创坏死组织清创治疗,并观察患者压痛症状消失时间、腹痛症状消失时间、并发症以及住院时间等治疗效果。结果通过研究发现,B组的治愈病例数(59例)较A组治愈病例数(45例)高,差异有统计学意义(P<0.05)。治疗期间,患者相关的压痛症状消失时间(A组5.5±0.7 d,B组2.9±0.8 d)、腹痛症状消失时间(A组68.3±14.2 h,B组21.4±9.3 h)、住院时间(A组37.3±24.3 d,B组26.3±15.2 d)以及并发症(A组16例,B组7例)等的差异相比,B组较A组的效果要好,差异有统计学意义(P<0.05)。结论联合微创清创治疗急性坏死性胰腺炎,能明显改善重症急性胰腺炎病情转归和预后,具有较好的临床效果,值得推广。

Objective To evaluate the clinical effects of multi-channel puncture and drainage combined with debridement of minimally invasive necrotic tissue in the treatment of acute necrotizing pancreatitis,and to provide guidance for the clinical treatment of acute necrotizing pancreatitis.Methods 130 cases of acute necrotizing pancreatitis treated in our hospital from January 2016 to December 2017 were divided into group A and group B.Among them,group A was treated with multi-channel abdominal puncture and drainage,and group B was treated with transperitoneal multi-channel puncture and drainage combined with debridement of minimally invasive necrotic tissue in the later period and the therapeutic effect of patients were observed.Results It was found that the number of cured cases in group B(59 cases)was higher than that in group A(45 cases),and the difference was statistically significant(P<0.05).During the treatment period,the time of disappearance of related tenderness symptoms(group A 5.5+0.7 d,group B 2.9+0.8 d),the time of disappearance of abdominal pain symptoms(group A 68.3+14.2 h,group B 21.4+9.3 h),hospitalization time(group A 37.3+24.3 d,group B 26.3+15.2 d)and complications(group A 16 cases,group B 7 cases)were better than group A,the difference was statistically significant(P<0.05).Conclusions Transabdominal multichannel abortion drainage combined with minimally invasive necrotic tissue debridement has a good effect in the treatment of acute necrotizing pancreatitis,with improved prognosis.It deserves to be further clinically applied.