CAJ | 학술논문

目的观察经皮置管负压冲洗联合内镜引流(PCD+ NPI+ ED)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2011年7月至2012年7月经PCD+ NPI+ED联合技术治疗的17例合并IPN的SAP患者的临床资料,分析临床治疗过程及预后.结果 17例患者IPN确诊距发病时间为(26.9 ±7.9)d.13例革兰阴性菌感染,3例革兰阳性菌感染,1例侵袭性真菌感染.首次PCD+ NPI治疗距发病时间为(34.8±11.6)d.B超引导下置管1例,CT引导下置管8例,B超和CT联合引导下置管8例,每例患者平均所置负压冲洗引流管为(3.5±1.2)根.首次ED治疗距首次PCD+ NPI时间为(26.7 ±9.6)d,每例患者平均ED治疗(2.1 ±0.9)次.2例中转剖腹手术引流,距确诊IPN时间分别为24d和56 d.17例患者均无PCD+ NPI置管相关并发症发生,第1例患者在ED治疗过程中发生出血,ED治疗后2例并发十二指肠瘘,1例并发高位空肠瘘,1例并发降结肠瘘,2例腹腔出血.无新发脏器功能障碍和脓毒血症.1例在PCD+ NPI+ ED联合治疗前即并发多器官功能不全和脓毒血症,虽中转剖腹手术引流仍无法有效控制脓毒血症而病死.结论 PCD+ NPI+ ED联合技术可使IPN患者避免剖腹手术引流,减少并发症发生,改善患者预后.
목적 관찰경피치관부압충세연합내경인류(PCD+ NPI+ ED)치료중증급성이선염(SAP)합병이선배사조직감염(IPN)적림상효과.방법 회고2011년7월지2012년7월경PCD+ NPI+ED연합기술치료적17례합병IPN적SAP환자적림상자료,분석림상치료과정급예후.결과 17례환자IPN학진거발병시간위(26.9 ±7.9)d.13례혁란음성균감염,3례혁란양성균감염,1례침습성진균감염.수차PCD+ NPI치료거발병시간위(34.8±11.6)d.B초인도하치관1례,CT인도하치관8례,B초화CT연합인도하치관8례,매례환자평균소치부압충세인류관위(3.5±1.2)근.수차ED치료거수차PCD+ NPI시간위(26.7 ±9.6)d,매례환자평균ED치료(2.1 ±0.9)차.2례중전부복수술인류,거학진IPN시간분별위24d화56 d.17례환자균무PCD+ NPI치관상관병발증발생,제1례환자재ED치료과정중발생출혈,ED치료후2례병발십이지장루,1례병발고위공장루,1례병발강결장루,2례복강출혈.무신발장기공능장애화농독혈증.1례재PCD+ NPI+ ED연합치료전즉병발다기관공능불전화농독혈증,수중전부복수술인류잉무법유효공제농독혈증이병사.결론 PCD+ NPI+ ED연합기술가사IPN환자피면부복수술인류,감소병발증발생,개선환자예후.
Objective To investigate the effectiveness of combining percutaneous catheter drainage (PCD),negative pressure irrigation (NPI) with endoscopic drainage (ED) for severe acute pancreatitis (SAP) patients with infected pancreatic necrosis (IPN).Methods The clinical data of 17 patients with IPN admitted from July 2011 to July 2012 were reviewed and the clinical course and outcome were analyzed.All the patients were treated with PCD + NPI + ED.ResuIis The time interval from onset of the disease to IPN diagnosis was (26.9 ±7.9) days.Thirteen cases were infected with gram-negative bacterium,3 cases with gram-positive bacterium and 1 case with invasive fungal.The time interval from onset to first PCD + NPI was (34.8 ± 11.6) days.Eight cases were treated with CT guidance,1 case with ultrasound guidance and 8 cases with both.The mean number of double catheterization cannulas in every patient was 3.5 ± 1.2.The time interval from first PCD + NPI to first ED was (26.7 ± 9.6) days and the mean ED treatment of every patient was (2.1 ±0.9) times.Among all patients,two were converted to open surgery and the time intervals from disease onset to operation in these two patients were 24 days and 56 days respectively.No catheterization related complication occurred in these 17 cases.Bleeding occurred in the first patient during the procedure of ED.After ED,duodenal fistula occurred in 2 patients,jejunal fistula occurred in 1 patient,descending colon fistula occurred in 1 patient,abdominal cavity bleeding occurred in 2 patients.No new cases of organ dysfunction and sepsis occurred.One patient developed multiple organ dysfunction and sepsis before PCD +NPI + ED treatment,though this patient underwent laparotomy,sepsis was not controlled and this patient died eventually.Conclusions Combination of PCD + NPI + ED can effectively avoid operation for most patients with IPN,and decrease complication rates and improve the prognosis of patients.