CAJ | 학술논문

目的：探讨经自然腔道内镜手术（NOTES）对重症急性胰腺炎（SAP）合并多器官功能障碍（MOD）的治疗价值。方法选择2010年3月至2014年10月中山大学附属东华医院收治的SAP患者99例，将其随机分为NOTES组51例和对照组48例。NOTES组患者入院4h内实施NOTES腹腔内镜治疗、腹腔灌洗、腹膜透析及综合治疗。NOTES组患者探查腹腔病变及实施内镜治疗，对照组患者采用非手术综合治疗，比较两组SAP患者的胃、肠、肺、肝、肾功能，治愈率和死亡率。结果入院第4、8、14天腹腔压力、胆红素、丙氨酸氨基转移酶（ALT）、白蛋白、肌酐、尿素氮值与对照组之间差异有统计学意义（P<0.05）。NOTES组患者治愈率98.0%，转科率为2%，两组治愈率、死亡率差异有统计学意义（P<0.01）。 NOTES组患者平均住院日（18.98±7.88）d，对照组患者平均住院日（56.85±20.54）d，两组差异有统计学意义（P<0.01）。结论以NOTES腹腔探查及微创治疗为先导的综合疗法，是治疗SAP合并MOD患者的有效模式。
목적：탐토경자연강도내경수술（NOTES）대중증급성이선염（SAP）합병다기관공능장애（MOD）적치료개치。방법선택2010년3월지2014년10월중산대학부속동화의원수치적SAP환자99례，장기수궤분위NOTES조51례화대조조48례。NOTES조환자입원4h내실시NOTES복강내경치료、복강관세、복막투석급종합치료。NOTES조환자탐사복강병변급실시내경치료，대조조환자채용비수술종합치료，비교량조SAP환자적위、장、폐、간、신공능，치유솔화사망솔。결과입원제4、8、14천복강압력、담홍소、병안산안기전이매（ALT）、백단백、기항、뇨소담치여대조조지간차이유통계학의의（P<0.05）。NOTES조환자치유솔98.0%，전과솔위2%，량조치유솔、사망솔차이유통계학의의（P<0.01）。 NOTES조환자평균주원일（18.98±7.88）d，대조조환자평균주원일（56.85±20.54）d，량조차이유통계학의의（P<0.01）。결론이NOTES복강탐사급미창치료위선도적종합요법，시치료SAP합병MOD환자적유효모식。
ObjectiveTo evaluate value of natural orifice transluminal endoscopic surgery(NOTES) in the treatment of abominal lesions of patients with multiple organ dysfunction (MOD) complicated with severe acute pancreatitis (SAP).MethodsThe patients with MOD complicated with SAP were randomly divided into two groups, i.e. NOTES group(NG) and control group(CG). Therapy with NOTES,abdominal cavity lavage and peritoneal dialysis in 4 hours of admitting to hospital and routine treatment was carried out in NG patients and non-operation routine treatment was performed in the CG patients. Peritoneoendoscopy and therapeutic endoscopy was performed for NG patients. The functions of stomach, intestine, lung, liver and kidneys, cure rates and mortality in NG was coampared with those in CG.ResultsThere was significant difference between NG and CG in intra-abdominal pressure,albumin,ALT,creatine and urea(P<0.05).The cure rate in NG was 98% and transfer rate was 2%,and the cure rate and mortality rate in NG has significantly different than those in CG(P<0.01).The average days of hospitalization in NG were (18.98±7.88) d and the average days of hospitalization in CG were (56.85±20.54) d. There was significant difference between NG and CG in the average days of hospitalization (P<0.01).ConclusionNOTES with minimally invasive therapy, abdominal cavity lavage and peritoneal dialysis before routine treatment were effective method to treat the patients with MOD complicated with SAP.