中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2010年
18期
1387-1391
,共5页
童智慧%李维勤%虞文魁%王新颖%叶向红%聂垚%柯路%徐晓帆%鲁俊%倪海滨%孙加奎%李宁%黎介寿
童智慧%李維勤%虞文魁%王新穎%葉嚮紅%聶垚%柯路%徐曉帆%魯俊%倪海濱%孫加奎%李寧%黎介壽
동지혜%리유근%우문괴%왕신영%협향홍%섭요%가로%서효범%로준%예해빈%손가규%리저%려개수
胰腺炎%引流术%胰腺坏死组织感染%经皮穿刺引流%手术引流
胰腺炎%引流術%胰腺壞死組織感染%經皮穿刺引流%手術引流
이선염%인류술%이선배사조직감염%경피천자인류%수술인류
Pancreatitis%Drainage%Infective pancreatic necrosis%Percutaneous drainage%Surgical drainage
目的 比较经皮穿刺置管引流和直接开腹手术引流治疗重症急性胰腺炎(SAP)合并胰腺坏死组织感染的临床效果.方法 回顾性分析2008年1月至2009年12月治疗的90例合并胰腺坏死组织感染的SAP患者的临床资料,根据针对感染的胰腺坏死组织首先采取的治疗方法的不同将患者分为经皮穿刺置管引流组和直接开腹手术引流组,其中经皮穿刺置管引流组27例,直接开腹手术引流组63例.经皮穿刺置管引流组首先在彩色超声或CT引导下穿刺置管引流,冲洗3 d后评价引流效果,无明显改善则中转开腹手术引流.直接开腹手术引流组在确诊胰腺坏死组织感染后直接开腹手术引流.结果 经皮穿刺置管引流组的避免开腹手术引流率(48.1%比0,P＜0.05)和一次开腹手术引流成功率(92.9%比85.7%,P＜0.05)均明显高于直接开腹手术引流组,而术后残余脓肿(7.1%比28.6%,P＜0.05)、术后新发单脏器功能障碍(7.4%比28.6%,P＜0.05)、新发消化道瘘(7.4%比27.0%,P＜0.05)、远期并发症(3.7%比22.2%,P＜0.05)的发生率均低于直接开腹手术引流组.此外,经皮穿刺置管引流组的平均ICU治疗时间[(21.2±9.7)d比(28.7±12.1)d,P＜0.01],平均住院时间[(48.2±12.5)d比(59.6±17.5)d,P＜0.05]和住院费用[(191 762±5892)元比(341 689±10 854)元,P＜0.05]均低于直接开腹手术引流组.结论 经皮穿刺置管引流能有效降低多次开腹手术引流率和术后残余脓肿发生率,治疗后近期和远期并发症的发生率均明显下降,并且平均ICU治疗时间、平均住院时间、平均住院费用明显下降.
目的 比較經皮穿刺置管引流和直接開腹手術引流治療重癥急性胰腺炎(SAP)閤併胰腺壞死組織感染的臨床效果.方法 迴顧性分析2008年1月至2009年12月治療的90例閤併胰腺壞死組織感染的SAP患者的臨床資料,根據針對感染的胰腺壞死組織首先採取的治療方法的不同將患者分為經皮穿刺置管引流組和直接開腹手術引流組,其中經皮穿刺置管引流組27例,直接開腹手術引流組63例.經皮穿刺置管引流組首先在綵色超聲或CT引導下穿刺置管引流,遲洗3 d後評價引流效果,無明顯改善則中轉開腹手術引流.直接開腹手術引流組在確診胰腺壞死組織感染後直接開腹手術引流.結果 經皮穿刺置管引流組的避免開腹手術引流率(48.1%比0,P＜0.05)和一次開腹手術引流成功率(92.9%比85.7%,P＜0.05)均明顯高于直接開腹手術引流組,而術後殘餘膿腫(7.1%比28.6%,P＜0.05)、術後新髮單髒器功能障礙(7.4%比28.6%,P＜0.05)、新髮消化道瘺(7.4%比27.0%,P＜0.05)、遠期併髮癥(3.7%比22.2%,P＜0.05)的髮生率均低于直接開腹手術引流組.此外,經皮穿刺置管引流組的平均ICU治療時間[(21.2±9.7)d比(28.7±12.1)d,P＜0.01],平均住院時間[(48.2±12.5)d比(59.6±17.5)d,P＜0.05]和住院費用[(191 762±5892)元比(341 689±10 854)元,P＜0.05]均低于直接開腹手術引流組.結論 經皮穿刺置管引流能有效降低多次開腹手術引流率和術後殘餘膿腫髮生率,治療後近期和遠期併髮癥的髮生率均明顯下降,併且平均ICU治療時間、平均住院時間、平均住院費用明顯下降.
목적 비교경피천자치관인류화직접개복수술인류치료중증급성이선염(SAP)합병이선배사조직감염적림상효과.방법 회고성분석2008년1월지2009년12월치료적90례합병이선배사조직감염적SAP환자적림상자료,근거침대감염적이선배사조직수선채취적치료방법적불동장환자분위경피천자치관인류조화직접개복수술인류조,기중경피천자치관인류조27례,직접개복수술인류조63례.경피천자치관인류조수선재채색초성혹CT인도하천자치관인류,충세3 d후평개인류효과,무명현개선칙중전개복수술인류.직접개복수술인류조재학진이선배사조직감염후직접개복수술인류.결과 경피천자치관인류조적피면개복수술인류솔(48.1%비0,P＜0.05)화일차개복수술인류성공솔(92.9%비85.7%,P＜0.05)균명현고우직접개복수술인류조,이술후잔여농종(7.1%비28.6%,P＜0.05)、술후신발단장기공능장애(7.4%비28.6%,P＜0.05)、신발소화도루(7.4%비27.0%,P＜0.05)、원기병발증(3.7%비22.2%,P＜0.05)적발생솔균저우직접개복수술인류조.차외,경피천자치관인류조적평균ICU치료시간[(21.2±9.7)d비(28.7±12.1)d,P＜0.01],평균주원시간[(48.2±12.5)d비(59.6±17.5)d,P＜0.05]화주원비용[(191 762±5892)원비(341 689±10 854)원,P＜0.05]균저우직접개복수술인류조.결론 경피천자치관인류능유효강저다차개복수술인류솔화술후잔여농종발생솔,치료후근기화원기병발증적발생솔균명현하강,병차평균ICU치료시간、평균주원시간、평균주원비용명현하강.
Objective To compare the clinical effectiveness of percutaneous US- or CT- guided drainage and laparotomy for patients with infective pancreatic necrosis. Methods Data of 90 infective pancreatic necrosis patients admitted from January 2008 to December 2009 were included. They were divided into two groups by the different treatment choices. Twenty-seven patients in the percutaneous group received percutaneous US- or CT- guided drainage as first choice. After that a sump suction apparatus was applied for controlled drainage. If no improvement was achieved after 3 days, they would received operation soon. While patients in the laparotomy group received surgical drainage at the time when the diagnosis of infected pancreatic necrosis was confirmed. Continous drainage was also applied for these ones. Results The percutaneous group had a significant low rate of reoperation(7.1% vs. 14. 3% ,P ＜0. 05) and postoperative residual abscesses ( 7.1% vs. 28. 6%, P ＜ 0. 05 ). Furthermore, 48. 1% of patients in percutaneous group successfully avoid laparotomy. In the regard of complications, the percutaneous group presented lower incidence of both single organ dysfunction ( 7.4% vs. 28.6%, P ＜ 0.05 ), intestinal fistula ( 7.4% vs.27.0%, P ＜ 0. 05 ) and long-term complications ( 3.7% vs. 22.2% , P ＜ 0. 05 ) . In addition, the percutaneous group costed less medical resources as evidenced by shorter ICU duration (21.2 ± 9. 7 vs.28. 7 ± 12. 1, P ＜ 0. 01 ), shorter hospital duration ( 48. 2 ± 12. 5 vs. 59. 6 ± 17.5, P ＜ 0. 05 ) and less expenditure( 191 762 ± 5892 vs. 341 689 ± 10 854, P ＜ 0. 05 ). Conclusions Percutaenous drainage can effectively lower the surgical rates and the rates of complications and reoperations in patients with infective pancreatic necrosis. Besides that, it could also reduce the cost of medical resources.
