中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2015年
9期
676-679
,共4页
辛宪磊%蔡守旺%刘志伟%何蕾%冯健%王鹏飞%唐茂盛%卢实春%董家鸿
辛憲磊%蔡守旺%劉誌偉%何蕾%馮健%王鵬飛%唐茂盛%盧實春%董傢鴻
신헌뢰%채수왕%류지위%하뢰%풍건%왕붕비%당무성%로실춘%동가홍
胰腺炎,急性坏死性%外科手术,微创性%开腹术后残余感染%肾镜
胰腺炎,急性壞死性%外科手術,微創性%開腹術後殘餘感染%腎鏡
이선염,급성배사성%외과수술,미창성%개복술후잔여감염%신경
Pancreatitis,acute necrotizing%Surgical procedures,minimally invasive%Postoperatively resident infection%Nephroscopic therapy
目的 探讨经皮肾镜微创治疗重症急性胰腺炎(SAP)开腹术后残余感染灶的方法及疗效.方法 回顾性分析自2008年6月至2014年12月解放军总医院采用经皮肾镜微创坏死组织清除术治疗15例SAP开腹治疗术后残余感染患者的资料.男性8例,女性7例,年龄22 ～ 71岁,平均42岁.患者发病至开腹手术时间:1 ～7 d 12例,15 ～21 d 1例,22～28 d 1例,127 d 1例.本组患者均采用先行CT引导下经皮穿刺置管引流,再行经皮肾镜坏死组织清除术,术后持续腹腔内冲洗的治疗方法.结果 15例患者中,11例接受肾镜治疗1次,2例2次,1例3次,1例4次;术后平均住院时间66.2 d(10～223 d);术后1例患者出现结肠瘘予以双套管冲洗治愈;1例出现腹腔内出血行动脉造影未见明显出血,后行剖腹探查止血;1例出现胰腺假性囊肿予以置管引流;1例出现严重的肺部感染.3例患者死亡,死因均为多器官功能衰竭.结论 经皮肾镜胰周坏死织清除术创伤小,避免再次开腹分离粘连、寻找坏死灶所带来的并发症,可能是治疗SAP术后残余感染的理想方法.
目的 探討經皮腎鏡微創治療重癥急性胰腺炎(SAP)開腹術後殘餘感染竈的方法及療效.方法 迴顧性分析自2008年6月至2014年12月解放軍總醫院採用經皮腎鏡微創壞死組織清除術治療15例SAP開腹治療術後殘餘感染患者的資料.男性8例,女性7例,年齡22 ～ 71歲,平均42歲.患者髮病至開腹手術時間:1 ～7 d 12例,15 ～21 d 1例,22～28 d 1例,127 d 1例.本組患者均採用先行CT引導下經皮穿刺置管引流,再行經皮腎鏡壞死組織清除術,術後持續腹腔內遲洗的治療方法.結果 15例患者中,11例接受腎鏡治療1次,2例2次,1例3次,1例4次;術後平均住院時間66.2 d(10～223 d);術後1例患者齣現結腸瘺予以雙套管遲洗治愈;1例齣現腹腔內齣血行動脈造影未見明顯齣血,後行剖腹探查止血;1例齣現胰腺假性囊腫予以置管引流;1例齣現嚴重的肺部感染.3例患者死亡,死因均為多器官功能衰竭.結論 經皮腎鏡胰週壞死織清除術創傷小,避免再次開腹分離粘連、尋找壞死竈所帶來的併髮癥,可能是治療SAP術後殘餘感染的理想方法.
목적 탐토경피신경미창치료중증급성이선염(SAP)개복술후잔여감염조적방법급료효.방법 회고성분석자2008년6월지2014년12월해방군총의원채용경피신경미창배사조직청제술치료15례SAP개복치료술후잔여감염환자적자료.남성8례,녀성7례,년령22 ～ 71세,평균42세.환자발병지개복수술시간:1 ～7 d 12례,15 ～21 d 1례,22～28 d 1례,127 d 1례.본조환자균채용선행CT인도하경피천자치관인류,재행경피신경배사조직청제술,술후지속복강내충세적치료방법.결과 15례환자중,11례접수신경치료1차,2례2차,1례3차,1례4차;술후평균주원시간66.2 d(10～223 d);술후1례환자출현결장루여이쌍투관충세치유;1례출현복강내출혈행동맥조영미견명현출혈,후행부복탐사지혈;1례출현이선가성낭종여이치관인류;1례출현엄중적폐부감염.3례환자사망,사인균위다기관공능쇠갈.결론 경피신경이주배사직청제술창상소,피면재차개복분리점련、심조배사조소대래적병발증,가능시치료SAP술후잔여감염적이상방법.
Objective To investigate the method and effect of percutaneous nephroscopic necrosectomy(PNN) for post-operatively resident infection of severe acute pancreatitis (SAP).Methods Data of the 15 SAP patients with post-operatively resident infection treated by PNN from June 2008 to December 2014 in Chinese People's Liberation Army General Hospital were reviewed.Twelve of the patients underwent the laparotomy within 1 week,1 in 3rd week,1 in 4th week and the other one on the 127th day.All of the referrals firstly received (multi-)percutaneous catheter drainage (PCD),and then PNN operation according to the disease,followed by continuous irrigation-drainage.Results Eleven patients were healed after received only one PNN operation,2 patients for twice,1 for three times and 1 for four times.The average post-operative time of hospital stay was 66.2 days(10-223 days).The complications after operation contained colon fistula (n ＝ 1),abdominal hemorrhage (n =1),pancreatic pseudocyst (n =1),severe pulmonary infection (n =1).Three patients eventually died.Conclusions Percutaneous nephroscopic necrosectomy is a minimally invasive approach which could prevent the complicated re-laparotomy operation,result in less complication.It is an ideal method for treating SAP patients with post-operatively resident infection.
