CAJ | 학술논문

目的评价CT引导下经皮穿刺置管负压引流联合腹膜透析治疗重症胰腺炎的有效性和安全性.方法回顾性分析82例重症胰腺炎患者资料.全部患者在病程的不同时期均实施CT引导下经皮穿刺置管负压引流及腹膜透析.结果 (1)82例患者均成功放置腹膜透析管并行腹膜透析,所有患者经腹膜透析后腹胀、腹痛症状较腹膜透析前明显缓解,所有患者均未发生腹膜透析相关性死亡.(2)82例患者均经CT引导下经皮穿刺置管负压引流,76例经穿刺置管引流后痊愈,置管引流治愈率92.7％ (76/82);6例患者因穿刺引流失败行外科手术引流;无导管相关性并发症发生.结论在急性重症胰腺炎病程早期采用腹膜透析可明显降低患者早期多脏器功能衰竭的发生率及病死率.随着急性重症胰腺炎病程进展至中后期,采用CT引导下经皮穿刺置管引流,可避免大部分患者行传统开腹清创引流,降低术后出现胃肠道损伤及瘘的发生率.该法治疗效果确切、并发症少,值得临床推广.
목적 평개CT인도하경피천자치관부압인류연합복막투석치료중증이선염적유효성화안전성.방법 회고성분석82례중증이선염환자자료.전부환자재병정적불동시기균실시CT인도하경피천자치관부압인류급복막투석.결과 (1)82례환자균성공방치복막투석관병행복막투석,소유환자경복막투석후복창、복통증상교복막투석전명현완해,소유환자균미발생복막투석상관성사망.(2)82례환자균경CT인도하경피천자치관부압인류,76례경천자치관인류후전유,치관인류치유솔92.7％ (76/82);6례환자인천자인류실패행외과수술인류;무도관상관성병발증발생.결론 재급성중증이선염병정조기채용복막투석가명현강저환자조기다장기공능쇠갈적발생솔급병사솔.수착급성중증이선염병정진전지중후기,채용CT인도하경피천자치관인류,가피면대부분환자행전통개복청창인류,강저술후출현위장도손상급루적발생솔.해법치료효과학절、병발증소,치득림상추엄.
Objective To investigate the efficacy and safety of percutaneous CT-guided puncture and negative pressure catheter drainage combined with peritoneal dialysis in the treatment of severe acute pancreatitis.Methods The clinical data of 82 patients with severe acute pancreatitis were retrospectively analyzed.At different stages of the disease,these patients were treated using CT-guided percutaneous puncture and negative pressure catheter drainage combined with peritoneal dialysis.Results (1) The procedures were successfully carried out in 82 patients with abdominal distension and pain.The abdominal pain significantly decreased after peritoneal dialysis.There was no peritoneal dialysis related death.(2) 82 patients underwent CT-guided percutaneous puncture and negative pressure catheter drainage.76 patients recovered after drainage.The cure rate was 92.7％ (76/82).6 patients underwent surgical drainage after failure of percutaneous puncture drainage.There was no catheter related complications.Conclusions In the early course of severe acute pancreatitis,peritoneal dialysis significantly reduced the incidence of multiple organ function failure and early mortality.With later progression of severe acute pancreatitis,CT-guided percutaneous puncture and catheter drainage and debridement avoided most patients from undergoing traditional laparotomy drainage,and reduced the incidence of gastrointestinal tract injury and postoperative fistula.The treatment provided clear benefits with fewer complications.