摘要
目的探讨早期腹腔微创穿刺引流治疗重症急性胰腺炎(SAP)的临床效果。方法回顾性分析63例重症急性胰腺炎患者的临床资料,按入院至接受腹腔微创穿刺引流的时间分为观察组33例与对照组30例。观察组患者入院至接受腹腔微创穿刺引流时间≤1周,对照组患者入院至接受腹腔微创穿刺引流时间>1周。比较两组症状及体征异常持续时间、血淀粉酶异常持续时间、血内毒素异常时间、住院期间胰腺坏死范围、炎症因子水平及早期腹腔微创穿刺引流后行超声引导下经皮穿刺置管引流(PCD)的相关情况,并统计分析治疗期间器官衰竭、感染等预后情况及住院相关情况。结果观察组患者症状及体征异常时间、血淀粉酶异常时间、血内毒素异常时间均短于对照组(P<0.05)。两组住院期间胰腺坏死范围比较,差异无统计学意义(P>0.05)。入院时,两组炎症因子水平比较,差异无统计学意义(P>0.05);行PCD前,两组TNF-α、CRP、IL-6、IL-10较入院时均下降(P<0.05),且观察组低于对照组(P<0.05)。观察组发病至首次PCD时间较对照组长,人均PCD导管数量较对照组少,PCD引流时间较对照组短,差异均有统计学意义(P<0.05)。两组人均PCD操作次数、PCD相关并发症发生率比较,差异无统计学意义(P>0.05)。观察组器官衰竭持续时间、住院时间较对照组短,住院费用低于对照组,差异有统计学意义(P<0.05)。两组多重细菌感染率、单细菌感染率、器官功能衰竭率、死亡率、ICU住院时间比较,差异均无统计学意义(P>0.05)。结论对于SAP患者,早期行腹腔微创穿刺引流,对缓解临床症状及体征、阻止器官功能持续衰竭、改善炎症反应等均有重要意义。
Objective To investigate the clinical effect of early minimally invasive percutaneous peritoneal drainage on severe acute pancreatitis (SAP). Methods The clinical data of 63 patients with SAP were analyzed retrospectively. According to the duration between admission and minimally invasive percutaneous peritoneal drainage, the patients were divided into observation group (33 cases;duration between admission and minimally invasive percutaneous peritoneal drainage ≤ 1 week) and control group (30 cases;duration between admission and minimally invasive percutaneous peritoneal drainage >1 week). Duration of abnormal symptoms and signs, duration of abnormal blood amylase, duration of abnormal serum endotoxin, extension of pancreatic necrosis during hospitalization, levels of inflammatory factors, and related conditions of ultrasound-guided percutaneous catheter drainage (PCD) after minimally invasive percutaneous peritoneal drainage were compared between the two groups. The conditions of organ failure and infection during treatment and hospitalization-related conditions were statistically analyzed. Results The duration of abnormal symptoms and signs, durations of abnormal blood amylase and endotoxin in the observation group were shorter than those in the control group( P <0.05). There was no statistically significant difference between the two groups in extension of pancreatic necrosis during hospitalization( P >0.05 ). No statistically significant difference was observed between the two groups in levels of inflammatory factors at admission( P >0.05). Before PCD, the levels of tumor necrosis factor(TNF)-α, C-reactive protein(CRP), interleukin(IL)-6 and IL-10 were decreased in the two groups compared with the levels at admission( P <0.05), and the observation group had lower levels than the control group( P <0.05). The observation group exhibited longer duration between disease onset and initial PCD, less number of PCD tubes per capita, and shorter duration of PCD drainage than the control group( P <0.05 ). There were
作者
陈文哲
肖强
毛盛名
CHEN Wenzhe;XIAO Qiang;MAO Shengming(Department of Hepatobiliary Surgery,the Sixth Affiliated Hospital of Guangzhou Medical University ,Qingyuan 511518,China)
出处
《微创医学》
2019年第2期145-149,共5页
Journal of Minimally Invasive Medicine
关键词
重症急性胰腺炎
腹腔微创穿刺引流
早期
胰腺功能
炎症因子
Severe acute pancreatitis
Minimally invasive percutaneous peritoneal drainage
Early stage
Pancreatic function
Inflammatory factor
