CAJ | 학술논문

目的研究围胰腺区域性微创治疗重症急性胰腺炎(SAP)的临床效果.方法在维持器官功能的基础上,54例SAP患者分为两组,A组(n=28)采用微创手术,入院即行床边局部麻醉置入自制腹腔双套管于胰腺区域持续冲洗,后期对结石患者采用腔镜技术清除结石;B组(n=26)采用开腹清除胰腺坏死组织,行胆道减压、胃造瘘、空肠造瘘,并置入腹腔双套管于胰腺区域.两组术后均用0.5%氟尿嘧啶生理盐水液进行围胰腺区域持续滚动盥洗引流.结果两组患者手术后腹腔引流液从暗红色血性逐渐清亮,淀粉酶含量1周后与入院时比较均显著下降(t=2.68,P=0.013;t=2.41,P=0.028).A组白细胞计数、体温、心率也较手术前显著改善(t=2.32,P=0.035;t=2.39,P=0.021;t=2.38,P=0.023).A组病死率、并发症发生率、住院时间和治疗总费用显著低于B组(χ~2=8.62,P=0.001;χ~2=6.35,P=0.014;t=2.22,P=0.034;t=2.67,P=0.010),但治愈率显著高于B组(χ~2=3.89,P=0.045).结论围胰腺区域性微创治疗SAP既能去除病因,又能充分引流、及时阻断SAP恶性病理循环.与开腹手术比较,微创美观,操作简便,并发症少,疗效显著.
목적 연구위이선구역성미창치료중증급성이선염(SAP)적림상효과.방법 재유지기관공능적기출상,54례SAP환자분위량조,A조(n=28)채용미창수술,입원즉행상변국부마취치입자제복강쌍투관우이선구역지속충세,후기대결석환자채용강경기술청제결석;B조(n=26)채용개복청제이선배사조직,행담도감압、위조루、공장조루,병치입복강쌍투관우이선구역.량조술후균용0.5%불뇨밀정생리염수액진행위이선구역지속곤동관세인류.결과 량조환자수술후복강인류액종암홍색혈성축점청량,정분매함량1주후여입원시비교균현저하강(t=2.68,P=0.013;t=2.41,P=0.028).A조백세포계수、체온、심솔야교수술전현저개선(t=2.32,P=0.035;t=2.39,P=0.021;t=2.38,P=0.023).A조병사솔、병발증발생솔、주원시간화치료총비용현저저우B조(χ~2=8.62,P=0.001;χ~2=6.35,P=0.014;t=2.22,P=0.034;t=2.67,P=0.010),단치유솔현저고우B조(χ~2=3.89,P=0.045).결론 위이선구역성미창치료SAP기능거제병인,우능충분인류、급시조단SAP악성병리순배.여개복수술비교,미창미관,조작간편,병발증소,료효현저.
Objective To investigate the clinical effect of the minimally invasive surgical treatment with per-panereat region for sever acute pancreatitis(SAP). Methods Fify-four cases of SAP were divided into two groups, patients of group A (n= 28) were given minimally invasive surgical treatments (step 1 :under local anesthesia,patients were put the home-made double cannula in the abdominal around the region of pancreas, step 2:patients with biliary stone were performed by laparoscopical operations). Patients of group B(n= 26) were treatment by open operations including biliary decompression, gastrostomy, jejunostomy,removing necrotic pancreatic organizations and putting the double cannula around the region of pancreas.Through double cannula around the pancreas area,all patient's cavity were persistently douched using 0.5%5-FU saline solution. Results Washed after one week, two groups patient's drainage fluid amylase concentration were decreased significantly (t=2.68, P=0.013; t= 2.41, P=0.028), patient' s white cell count, body temperature, heart rate of Groups A were also decreased significantly (t=2.32, P=0.035;t=2.39,P=0.021; t=2.38, P=0.023) . Compared with group B, the mortality, the incidence of complications, hospitalization time and total cost of treatment of group A patients were significantly lower than that of group B(X~2 =8.62,P=0.001 ;X~2 =6.35,P=0.014;t=2.22,P=0.034;t=2.67,P=0.010) ,but the cure rate was significantly higher than that of group B (X~2= 3.89, P=0.045). Conclusions Minimally invasive surgical treatment of per-pancreatic region for SAP can not only remove the causes, but also fully drainage and timely block the pathological vicious cycle of SAP. What is more, it is simple, minimally invasive and have few complications and significant effect.