中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2013年
6期
493-498
,共6页
孙备%宋增福%姜洪池%白雪巍%王刚%李军%谭宏涛%孔瑞%刘杰
孫備%宋增福%薑洪池%白雪巍%王剛%李軍%譚宏濤%孔瑞%劉傑
손비%송증복%강홍지%백설외%왕강%리군%담굉도%공서%류걸
胰腺炎,急性坏死性%穿刺抽液术%外科手术,微创性
胰腺炎,急性壞死性%穿刺抽液術%外科手術,微創性
이선염,급성배사성%천자추액술%외과수술,미창성
Pancreatitis,acute necrotizing%Paracentesis%Surgical procedures,minimally invasive
目的 探讨创伤递升式分阶段处理重症急性胰腺炎(SAP)的可行性及临床应用价值.方法 回顾性分析2002年1月至2006年12月直接开腹胰腺坏死组织清除及2007年1月至2011年12月分阶段处理的SAP患者临床资料.其中,直接开腹组58例,男性37例,女性21例,年龄20～72岁,平均47.6岁；分阶段组63例,男性42例,女性21例,年龄19 ～78岁,平均46.2岁.分阶段处理首先行B超引导下经皮穿刺置管引流术,根据病情进展进一步选择沿穿刺管小切口胰腺坏死组织清除.比较两组术后并发症发生率、病死率、医疗费用、住院时间等.结果 分阶段组术后总体并发症发生率、器官功能不全、消化道漏及切口疝发生率明显低于直接开腹组(31.7％比62.1％,14.3％比37.5％,6.3％比19.0％,9.5％比29.3％；x2=4.43 ～ 11.17,P=0.001 ～0.035).其他并发症两组差异无统计学意义(P＞0.05).分阶段组输血率更低(44.4％比70.7％,x2=8.488,P=0.004),输血费用及住院费用减少[(2525±4573)元比(4770±6867)元,t=2.131,P=0.035;(171 213±50917)元比(237 874±67 832)元,t=2.496,P=0.014].两组患者住院时间及病死率差异无统计学意义(P＞0.05).结论 创伤递升式分阶段处理SAP能降低并发症发生率、减少输血及降低住院费用,具有临床可行性及应用价值.
目的 探討創傷遞升式分階段處理重癥急性胰腺炎(SAP)的可行性及臨床應用價值.方法 迴顧性分析2002年1月至2006年12月直接開腹胰腺壞死組織清除及2007年1月至2011年12月分階段處理的SAP患者臨床資料.其中,直接開腹組58例,男性37例,女性21例,年齡20～72歲,平均47.6歲；分階段組63例,男性42例,女性21例,年齡19 ～78歲,平均46.2歲.分階段處理首先行B超引導下經皮穿刺置管引流術,根據病情進展進一步選擇沿穿刺管小切口胰腺壞死組織清除.比較兩組術後併髮癥髮生率、病死率、醫療費用、住院時間等.結果 分階段組術後總體併髮癥髮生率、器官功能不全、消化道漏及切口疝髮生率明顯低于直接開腹組(31.7％比62.1％,14.3％比37.5％,6.3％比19.0％,9.5％比29.3％；x2=4.43 ～ 11.17,P=0.001 ～0.035).其他併髮癥兩組差異無統計學意義(P＞0.05).分階段組輸血率更低(44.4％比70.7％,x2=8.488,P=0.004),輸血費用及住院費用減少[(2525±4573)元比(4770±6867)元,t=2.131,P=0.035;(171 213±50917)元比(237 874±67 832)元,t=2.496,P=0.014].兩組患者住院時間及病死率差異無統計學意義(P＞0.05).結論 創傷遞升式分階段處理SAP能降低併髮癥髮生率、減少輸血及降低住院費用,具有臨床可行性及應用價值.
목적 탐토창상체승식분계단처리중증급성이선염(SAP)적가행성급림상응용개치.방법 회고성분석2002년1월지2006년12월직접개복이선배사조직청제급2007년1월지2011년12월분계단처리적SAP환자림상자료.기중,직접개복조58례,남성37례,녀성21례,년령20～72세,평균47.6세；분계단조63례,남성42례,녀성21례,년령19 ～78세,평균46.2세.분계단처리수선행B초인도하경피천자치관인류술,근거병정진전진일보선택연천자관소절구이선배사조직청제.비교량조술후병발증발생솔、병사솔、의료비용、주원시간등.결과 분계단조술후총체병발증발생솔、기관공능불전、소화도루급절구산발생솔명현저우직접개복조(31.7％비62.1％,14.3％비37.5％,6.3％비19.0％,9.5％비29.3％；x2=4.43 ～ 11.17,P=0.001 ～0.035).기타병발증량조차이무통계학의의(P＞0.05).분계단조수혈솔경저(44.4％비70.7％,x2=8.488,P=0.004),수혈비용급주원비용감소[(2525±4573)원비(4770±6867)원,t=2.131,P=0.035;(171 213±50917)원비(237 874±67 832)원,t=2.496,P=0.014].량조환자주원시간급병사솔차이무통계학의의(P＞0.05).결론 창상체승식분계단처리SAP능강저병발증발생솔、감소수혈급강저주원비용,구유림상가행성급응용개치.
Objective To investigate the feasibility and clinical value of the step-up approach for severe acute pancreatitis (SAP).Methods Clinical data of 121 SAP patients admitted between January 2002 and December 2011 were retrospectively analyzed.Fifty-eight patients (37 males and 21 females,aged from 20 to 72 years,mean 47.6 years) in the group of direct open necrosectomy from January 2002 to December 2006 were performed laparotomy through removal of all necrotic tissue.Sixty-three patients (42 males and 21 females,aged from 19 to 78 years,mean 46.2 years) of step-up approach from January 2007 to December 2011 underwent percutaneous catheter drainage through retroperitoneum or omental bursa guided by B-type ultrasonography for the first therapy,and then,according to the pathogenetic condition,if necessary,followed by a small incisional necrosectomy along the drainage tube.The two groups were compared for the rates of postoperative complications,death,transfusion and length of stay,medical costs.Results The rates of total postoperative complications,organ dysfunction,alimentary tract fistula and incisional hernia in step-up approach group were significantly lower than those of direct open necrosectomy group (31.7％ vs.62.1％,14.3％ vs.37.5％,6.3％ vs.19.0％,9.5％ vs.29.3％; x2=4.43 to 11.17,P =0.001 to 0.035).The other complications had no significant differences between the two groups (P ＞ 0.05).Patients in step-up approach group had a lower rates of transfusion (44.4％ vs.70.7％,x2 =8.488,P =0.004),fewer medical costs of transfusion and hospital stay,compared with those in direct open necrosectomy group ((2525 ± 4573) yuan vs.(4770 ± 6867) yuan,t =2.131,P =0.035 ; (171 213 ±50 917) yuan vs.(237 874 ±67 832) yuan,t =2.496,P =0.014).There were no significant differences of length of stay and mortality between two groups (P ＞ 0.05).Conclusion Step-up approach for SAP which can reduce the rates of postoperative complications,transfusion and medical costs has significant feasibility and great clinical value.
