CAJ | 학술논문

【目的】探析CT引导穿刺引流联合经皮肾镜微创治疗急性重症胰腺炎（ASP）合并胰周组织坏死的效果。【方法】取2011年2月至2013年11月本院收治的20例确诊为ASP合并胰周组织坏死患者，其中4例为高脂血症所致胰腺炎，胆源性胰腺炎16例，为初治患者。所有患者入院因脾脏、胃肠道、胆道等遮挡，无适当的穿刺路径，超声穿刺置管引流改行CT引导下穿刺引流联合经皮肾镜治疗。【结果】①患者CT引导下穿刺抽液细菌学检查为肠球菌、大肠杆菌、假单胞菌属、变形杆菌、霉菌单一细菌感染或两种以上细菌混合感染。②C T引导经皮穿刺引流成功率100％，16例经皮肾镜清除胰腺坏死感染组织1次后，炎症感染症状迅速控制，1例术中解剖结构粘连，转开腹手术，2例因术中坏死组织清除不彻底行二次手术，1例高脂血症性胰腺炎外院转入，术后并发多功能脏器衰竭。③15例患者术后5～9 d好转后经治愈出院，4例术后14～17 d住院带管出院，1例并发多脏器功能衰竭治疗4周后病情好转。无死亡病例，所有患者平均住院时间（13．5±1．6）d。【结论】对ASP合并胰周组织坏死者，在临床生命体征控制稳定后，结合临床传统的内外科治疗手段，采取CT引导下引流经皮肾镜微创技术，可最大程度降低手术对机体的创伤，清除坏死感染组织，促进病情好转，取得较好的疗效。
【목적】탐석CT인도천자인류연합경피신경미창치료급성중증이선염（ASP）합병이주조직배사적효과。【방법】취2011년2월지2013년11월본원수치적20례학진위ASP합병이주조직배사환자，기중4례위고지혈증소치이선염，담원성이선염16례，위초치환자。소유환자입원인비장、위장도、담도등차당，무괄당적천자로경，초성천자치관인류개행CT인도하천자인류연합경피신경치료。【결과】①환자CT인도하천자추액세균학검사위장구균、대장간균、가단포균속、변형간균、매균단일세균감염혹량충이상세균혼합감염。②C T인도경피천자인류성공솔100％，16례경피신경청제이선배사감염조직1차후，염증감염증상신속공제，1례술중해부결구점련，전개복수술，2례인술중배사조직청제불철저행이차수술，1례고지혈증성이선염외원전입，술후병발다공능장기쇠갈。③15례환자술후5～9 d호전후경치유출원，4례술후14～17 d주원대관출원，1례병발다장기공능쇠갈치료4주후병정호전。무사망병례，소유환자평균주원시간（13．5±1．6）d。【결론】대ASP합병이주조직배사자，재림상생명체정공제은정후，결합림상전통적내외과치료수단，채취CT인도하인류경피신경미창기술，가최대정도강저수술대궤체적창상，청제배사감염조직，촉진병정호전，취득교호적료효。
[Objective] To explore the efficacies of computed tomography (CT )‐guided puncture drainage plus percutaneous nephroscope for peripancreatic abscess (PA ) due to acute severe pancreatitis (ASP ) .[Methods] A total of 20 patients with PA due to ASP were recruited from our emergency department from February 2011 to November 2013 .The etiologies were idiopathic ( n=4) and gallstone ( n=16) .All patients were admitted because of shades of spleen ,gastrointestinal tract or billiary tract .No proper puncture path was available .Ultrasonic drainage tube was switched to CT‐guided puncture drainage with percutaneous nephro‐scope .[Results] (1) Bacteriological examination of CT‐guided puncture liquid revealed a single or dual infec‐tion of enterococcus ,Escherichia coli ,pseudomonas ,proteus and fungus ;(2) CT‐guided percutaneous punc‐ture yielded a drainage rate of 100% .After one‐time removal of pancreatic necrosis ,the infections were quick‐ly controlled in 16 cases .One case of intraoperative adhesion of anatomical structures was converted to undergo open operation .Two cases with residual necrotic tissues were re‐operated .And one case of hyperlipidemia was transferred from another hospital and had a postoperative onset of multifunctional organ failure ;(3) Fifteen curative cases were discharged at Days 5~9 .And 4 cases left with a tube at Days 14~17 .One case complicat‐ed with multiple organ failure improved after 4‐week treatment .There was no mortality .And the average length of hospital stay was (13 .5 ± 1 .6) days .[Conclusion] After a stabilization of vital signs ,puncture drainage under CT‐guided percutaneous nephroscope may minimize tissue trauma ,remove necrotic tissues and obtain optimal outcomes .