摘要
目的观察围胰腺区域分步微创治疗重症急性胰腺炎(SAP)的临床疗效。方法 2003年9月至2009年10月南方医科大学珠江医院肝胆一科对收治的36例SAP病人入院后在实施内科药物治疗同时,立即行局麻下腹部小切口于胰腺上下缘置入腹腔双套管,采用5-FU生理盐水持续滚动冲洗;合并化脓性胆管炎者同时行Oddi括约肌切开取石术(EST)或鼻胆管引流(ENBD)。合并胆囊结石者二期行腹腔镜胆囊切除术(LC),合并胆囊结石和胆总管结石者二期行LC加胆总管切开取石或EST。结果经围胰腺区域微创置管冲洗引流1周后,SAP病人腹腔引流液淀粉酶含量、血淀粉酶含量及白细胞等显著下降(t=2.68,P=0.013;t=2.41,P=0.028;t=2.32,P=0.035)。36例病人全程微创治疗成功,好转率100%,治愈率94.44%,病死率为0。结论围胰腺区域分步微创治疗SAP疗效显著,术后并发症发生率低,值得临床推广应用。
Objective To investigate the clinical effect of step by step minimally invasive surgery around panereat region for patients with severe acute pancreatitis （SAP）. Methods Thirty-six patients with SAP admitted between September 2003 and October 2009 at the Department of Hepatobiliary Surgery. I , Zhujiang Hospital of Southern Medical University were performed medical treatment. At the same time, pattens were also given minimally invasive treatments step by step. stepl ： With local anesthesia, patients were put the home-made double drainage tube in peritoneal cavity around the region of pancreas, and pattens with acute suppurative cholangitis （ASC） also performed by emergency surgery such as endoscopic sphincterotomy （EST） or endoscopic nasobilial＇y drainage （ENBD）. Through double drainage tube, all patient＇ s cavity was persistently douched using 0.5% 5-FU saline solution, step2： After the symptoms of SAP was controlled, patients with biliary stone were perlbrmed by laparoscopically operations including laparoscopic eholecystectomy（LC）, laparoscopic common bile duct lithotomy, EST, etc. Results All 36 SAP patients were performed with fldl of minimally invasive therapy successfully. Patient＇ s drainage fluid amylase concentration, blood amylase concentration and leukocytes were decreased significantly after one week （t=2.68, P=0.0113;t=2.41, P=0.028;t= 2.32, P=0.035 ）. The cure rate, improvement rate and mortality rate of 36 cases was 94.44%, 100% and zero respectively. Conclusion Step by step minimally invasive surgical treatment around pancreatic region for SAP have many advantages including minimally invasive, few complications and significant effect. The therapeutic schedule should have potential value tor clinical application.
出处
《中国实用外科杂志》
CSCD
北大核心
2010年第5期381-383,共3页
Chinese Journal of Practical Surgery
关键词
重症急性胰腺炎
胰腺区域:微创
severe acute pancreatitis（SAP）
pancreatic： region
minimally invasive
