摘要
目的探究不同内镜手术(经皮肾镜vs腹腔镜)对重症急性胰腺炎(severe acute pancreatitis,SAP)伴感染性胰腺坏死(infectious pancreatic necrosis,IPN)的治疗效果及预后的影响。方法纳入驻马店市中心医院2019年6月—2021年6月期间驻马店市中心医院61例SAP伴IPN患者,两组均在CT引导下行PCD,按照清创术式不同分为肾镜组(31例)和腹腔镜组(30例),比较两组患者一般资料、手术指标、临床检测指标、手术并发症、转归及预后。结果两组SAP伴IPN患者一般资料差异无统计学意义(P>0.05)。两组患者均顺利完成手术,肾镜组术后3例接受二次窦道清理,腹腔镜组2例疗效不佳中转开腹。肾镜组手术时间、术后带管时间、术后排气时间、术后住院时间为(52.84±7.66)min、(18.36±1.25)min、(21.58±1.29)min、(46.35±3.52)d,均短于腹腔镜组的(56.93±6.28)min、(20.61±2.39)min、(22.64±2.54)min、(49.22±3.17)d(P<0.05),肾镜组住院费用、手术出血量为(8.54±1.77)万元、(52.31±6.82)mL,均稍低于腹腔镜组的(10.29±1.63)万元、(61.85±7.24)mL(P<0.05)。两组术前临床检测指标差异无统计学意义(P>0.05),术后1 d、1周白细胞总数(WBC)逐渐减少,血清淀粉酶(AMS)、血糖、C反应蛋白(CRP)、降钙素原(PCT)、白介素-6(IL-6)逐渐降低,但两组差异无统计学意义(P>0.05)。随访1年,两组肠瘘、胰瘘、感染性休克、胰腺假性囊肿、窦道/腹腔出血等并发症发生率差异无统计学意义(P>0.05)。肾镜组死亡3例,腹腔镜组死亡4例,两组术后病死率差异无统计学意义(P>0.05)。结论经皮肾镜手术和腹腔镜手术均可以显著改善SAP并发IPN患者的感染中毒症状,具有明确疗效,但经皮肾镜手术在节省患者时间成本、医疗费用方面更具优势,且不会增加手术并发症发生率。
Objective To investigate the effects and prognosis of different endoscopic surgeries(percutaneous nephroscopy versus laparoscopy)in the treatment of severe acute pancreatitis(SAP)complicated with infectious pancreatic necrosis(IPN).Methods A total of 61 patients with SAP and IPN who underwent CT-guided PCD between June 2019 and June 2021 were included in this study.The patients were divided into the nephroscopy group(31 cases)and the laparoscopy group(30 cases)according to different debridement methods.The general data,surgical indicators,clinical indicators,surgical complications,outcomes and prognosis of the two groups were comparatively analyzed.Results There was no statistically significant difference in general data between the two groups(P>0.05).All patients in the two groups successfully completed the surgery.3 patients in the nephroscopy group underwent secondary sinus clearance after surgery,and 2 patients in the laparoscopy group were converted to laparotomy due to poor curative effect.The operation time,postoperative tube-carrying time,postoperative exhaust time,postoperative hospital stay,hospitalization costs and intraoperative blood loss of the nephroscopy group[(52.84±7.66)min,(18.36±1.25)d,(21.58±1.29)min,(46.35±3.52)d,(85.4±17.7)thousand yuan and(52.31±6.82)mL]were shorter/lower/less than those of the laparoscopy group[(56.93±6.28)min,(20.61±2.39)d,(22.64±2.54)min,(49.22±3.17)d,(102.9±16.3)thousand yuan and(61.85±7.24)mL](P<0.05).There was no statistically significant difference in clinical indicators between the two groups before operation(P>0.05).White blood cell count(WBC),serum amylase(AMS),blood glucose,C-reactive protein(CRP),procalcitonin(PCT),and interleukin-6(IL-6)decreased on day 1 and at 1 week after operation,but there was no statistically significant difference between the groups(P>0.05).The incidence of intestinal fistula(6.45%vs.3.33%),pancreatic fistula(6.45%vs.3.33%),septic shock(9.68%vs.20.00%),pancreatic pseudocyst(3.23%vs.6.67%)and sinus/abdominal bleeding(12.90%vs
作者
彭飞
张华甫
罗晓
PENG Fei;ZHANG Hua-fu;LUO Xiao(Emergency Department,Zhumadian Central Hospital,Zhumadian,Henan 463000,China;Outpatient Department,Zhumadian Central Hospital,Zhumadian,Henan 463000,China)
出处
《医药论坛杂志》
2023年第21期76-81,共6页
Journal of Medical Forum
关键词
重症急性胰腺炎
感染性胰腺坏死
经皮肾镜
腹腔镜
疗效
预后
Severe acute pancreatitis
Infectious pancreatic necrosis
Percutaneous nephroscopy
Laparoscopy
Curative effect
Prognosis
