中华胰腺病杂志
中華胰腺病雜誌
중화이선병잡지
CHINESE JOURNAL OF PANCREATOLOGY
2012年
5期
302-305
,共4页
童智慧%吴丛业%李维勤%李刚%张璐瑶%聂垚%李宁%黎介寿
童智慧%吳叢業%李維勤%李剛%張璐瑤%聶垚%李寧%黎介壽
동지혜%오총업%리유근%리강%장로요%섭요%리저%려개수
胰腺炎,急性坏死性%引流术%经皮置管引流%内镜引流%手术引流
胰腺炎,急性壞死性%引流術%經皮置管引流%內鏡引流%手術引流
이선염,급성배사성%인류술%경피치관인류%내경인류%수술인류
Pancreatitis,acute necrotizing%Drainage%Percutaneous catheter drainage%Endoscopic drainage%Opertation
目的 观察经皮置管加负压冲洗引流治疗重症急性胰腺炎(SAP)合并胰腺坏死组织感染(IPN)的临床效果.方法 回顾性分析2010年1月至2011年12月治疗的71例SAP合并IPN患者的临床资料,根据采取的置管引流疗式分为经皮置管引流(PCD)组(52例)和PCD+负压冲洗(NPI)组(19例).PCD组置入猪尾巴引流管间断冲洗引流IPN；PCD+ NPI组置入负压冲洗引流管持续负压冲洗引流IPN.中转开腹手术指征为置管引流3d后全身情况无改善；出现脓毒性休克、腹腔大出血、消化道瘘等并发症；引流3周后IPN缩小的范围≤1/2.结果 PCD+ NPI组中转开腹手术率为15.8％(3/19),明显低于 PCD组48.1％ (25/52,P＜0.05)；内镜引流7例(36.8％),明显多于PCD组0例(P＜0.01)；首次置管距中转开腹手术时间为(22±11)d,明显晚于 PCD组的(10±6)d(P ＜0.05).两组每例平均置管次数及置管根数、开腹手术次数、开腹手术并发症发生率的差异均无统计学意义.PCD+NPI组病死率为15.8％ (3/19),PCD组为13.5％( 7/52),两组差异无统计学意义.PCD+ NPI组患者的ICU治疗天数、住院天数、住院费用均低于 PCD组,但差异无统计学意义 结论 PCD+ NPI可有效降低IPN患者中转开腹手术率.
目的 觀察經皮置管加負壓遲洗引流治療重癥急性胰腺炎(SAP)閤併胰腺壞死組織感染(IPN)的臨床效果.方法 迴顧性分析2010年1月至2011年12月治療的71例SAP閤併IPN患者的臨床資料,根據採取的置管引流療式分為經皮置管引流(PCD)組(52例)和PCD+負壓遲洗(NPI)組(19例).PCD組置入豬尾巴引流管間斷遲洗引流IPN；PCD+ NPI組置入負壓遲洗引流管持續負壓遲洗引流IPN.中轉開腹手術指徵為置管引流3d後全身情況無改善；齣現膿毒性休剋、腹腔大齣血、消化道瘺等併髮癥；引流3週後IPN縮小的範圍≤1/2.結果 PCD+ NPI組中轉開腹手術率為15.8％(3/19),明顯低于 PCD組48.1％ (25/52,P＜0.05)；內鏡引流7例(36.8％),明顯多于PCD組0例(P＜0.01)；首次置管距中轉開腹手術時間為(22±11)d,明顯晚于 PCD組的(10±6)d(P ＜0.05).兩組每例平均置管次數及置管根數、開腹手術次數、開腹手術併髮癥髮生率的差異均無統計學意義.PCD+NPI組病死率為15.8％ (3/19),PCD組為13.5％( 7/52),兩組差異無統計學意義.PCD+ NPI組患者的ICU治療天數、住院天數、住院費用均低于 PCD組,但差異無統計學意義 結論 PCD+ NPI可有效降低IPN患者中轉開腹手術率.
목적 관찰경피치관가부압충세인류치료중증급성이선염(SAP)합병이선배사조직감염(IPN)적림상효과.방법 회고성분석2010년1월지2011년12월치료적71례SAP합병IPN환자적림상자료,근거채취적치관인류료식분위경피치관인류(PCD)조(52례)화PCD+부압충세(NPI)조(19례).PCD조치입저미파인류관간단충세인류IPN；PCD+ NPI조치입부압충세인류관지속부압충세인류IPN.중전개복수술지정위치관인류3d후전신정황무개선；출현농독성휴극、복강대출혈、소화도루등병발증；인류3주후IPN축소적범위≤1/2.결과 PCD+ NPI조중전개복수술솔위15.8％(3/19),명현저우 PCD조48.1％ (25/52,P＜0.05)；내경인류7례(36.8％),명현다우PCD조0례(P＜0.01)；수차치관거중전개복수술시간위(22±11)d,명현만우 PCD조적(10±6)d(P ＜0.05).량조매례평균치관차수급치관근수、개복수술차수、개복수술병발증발생솔적차이균무통계학의의.PCD+NPI조병사솔위15.8％ (3/19),PCD조위13.5％( 7/52),량조차이무통계학의의.PCD+ NPI조환자적ICU치료천수、주원천수、주원비용균저우 PCD조,단차이무통계학의의 결론 PCD+ NPI가유효강저IPN환자중전개복수술솔.
Objective To observe the clinical effectiveness of percutaneous catheter drainage ( PCD ) and PCD + negative pressure irrigation ( PCD + NPI ) for treatment of severe acute pancreatitis ( SAP ) patients with infective pancreatic necrosis (IPN).Methods Data of 71 IPN patients admitted from January 2010 to December 2011 were included and retrospectively analyzed.They were divided into two groups by the different treatment choices:PCD group (52 patients) and PCD + NPI group (19 patients).In PCD group,percutaneous pig-tail drainage catheter was inserted for intermittent IPN drainage,and in PCD + NPI group,negative pressure irrigation catheter was inserted for continuous IPN drainage.The indication for laparotomy surgery was no improvement after PCD or PCD + NPI for 3 days,or septic shock,abdominal cavity bleeding,digestive tract fistula occurred,the area of IPN decreased less than 1/2.Results The surgery rate of PCD +NPI group was 15.8％,which were significantly lower than that in PCD group (48.1％,P ＜0.05).7(36.8％ ) patients in PCD + NPI group received endoscopic drainage,which were significantly higher than that in PCD (0,P ＜0.05).The time interval between initial tube placement and operation in the PCD + NPI group was (22 ± 11 ) d,which were significantly longer than that in PCD group [ ( 10 ± 6 ) d,P ＜ 0.05 ].The difference of mean session and number of tube placement,number of laparotomy surgery,complications of laparotomy surgery in the two groups was not statistically significant.The mortality rate in the PCD + NPI group was 15.8％,which was not significantly higher than that in PCD group ( 13.5％ ).The ICU days,length of hospital stay and hospital costs in PCD + NPI group were lower than those in the PCD group,but the difference between the two groups was not statistically significant.Conclusions PCD + NPI can effectively reduce operation rate for patients with infective pancreatic necrosis.
