摘要
目的探讨重症急性胰腺炎(SAP)患者予以围胰腺区域分步微创治疗的临床疗效及预后。方法回顾性分析2013年1月-2014年12月攀枝花市中心医院诊治的SAP患者110例,按治疗方案的不同分为对照组和治疗组,每组各55例,对照组行开腹手术治疗,研究组行围胰腺区域分步微创治疗,比较两组患者术后的近期疗效、急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、实验室指标[血清淀粉酶(AMS)、白细胞(WBC)、C-反应蛋白(CRP)]及肠道功能恢复时间、并发症发生率和病死率。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果研究组的近期显效率、有效率及总有效率均优于对照组,两组间比较差异均有统计学意义(χ2值分别为5.1665、4.9865、5.6357,P值均<0.05);两组患者术后1周和出院时的AMS、WBC、血氧饱和度(Sp O2)、CRP水平及APACHEⅡ评分组间比较,差异均有统计学意义(术后1周t值分别13.6585、13.4698、12.0566、14.6856、13.8869,出院时t值分别12.8946、14.2683、13.8963、14.8989、13.0986,P值均<0.05);两组患者术后1 d的WBC比较差异有统计学意义(χ2=12.6984,P<0.05);两组患者术后1周和出院时的AMS、WBC、Sp O2、CRP水平及APACHEⅡ评分均较术后1 d发生明显改善,且研究组改善幅度更大,差异均有统计学意义(P值均<0.05);研究组患者的肠道功能恢复时间、病死率和并发症(胸腔积液、呼吸困难、假阳性囊肿、创口感染)发生率均低于对照组,两组间比较差异均有统计学意义(t=13.6985,P=0.042,χ2值分别为8.3968、5.6357、4.0673、4.0371、4.4071,P值均<0.05)。结论围胰腺区域分步微创治疗SAP患者疗效显著,且可积极改善患者预后,具有临床应用价值。
Objective To investigate the clinical effect and prognosis of peri- pancreatic stepwise minimally invasive treatment in patients with severe acute pancreatitis（ SAP）. Methods The clinical data of 110 patients with SAP who were treated in Panzhihua Central Hospital from January 2013 to December 2014 were analyzed retrospectively,and these patients were divided into two groups（ 55 patients in each group） according to the treatment regimen. The patients in the control group were treated with laparotomy,and those in the study group received peri- pancreatic stepwise minimally invasive treatment. The postoperative short- term treatment outcome,Acute Physiology and Chronic Health Evaluation Ⅱ（ APACHE Ⅱ） score,laboratory markers [serum amylase（ AMS）,white blood cell（ WBC）,and C- reactive protein（ CRP） ],time to intestinal recovery,incidence of complications,and mortality were compared between the two groups. The t- test was applied for comparison of continuous data between the two groups,and the chi- square test was applied for comparison of categorical data between the two groups. Results Compared with the control group,the study group had significantly higher short- term marked response rate,response rate,and overall response rate（ χ2= 5. 1665,4. 9865 and 5. 6357,all P 〈 0. 05）. There were significant differences in AMS,WBC,pulse oxygen saturation（ Sp O2）,CRP,and APACHE Ⅱ score between the two groups at 1 week after surgery and at discharge（ t =13. 6585,13. 4698,12. 0566,14. 6856,and 13. 8869 for 1 week after surgery,t = 12. 8946,14. 2683,13. 8963,14. 8989,and 13. 0986 for discharge,all P 〈 0. 05）; there was a significant difference in WBC count on day 1 after surgery between the two groups（ χ2= 12. 6984,P 〈 0. 05）; both groups showed significant improvements in AMS,WBC,Sp O2,CRP,and APACHE Ⅱ score at 1 week after surgery and at discharge compared with the values on day 1 after surgery,and there were significant changes in these values within each group（ all P
出处
《临床肝胆病杂志》
CAS
2016年第3期533-536,共4页
Journal of Clinical Hepatology
关键词
胰腺炎
外科手术
微创性
治疗结果
pancreatitis
surgical procedures,minimally invasuve
treatment outcome
