中国实用外科杂志

中国实用外科杂志

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微创腹膜后入路胰腺坏死组织清除术治疗感染性胰腺坏死18例疗效分析

黄耿文，申鼎成，亢    浩，周书毅   

  1. 中南大学湘雅医院胰胆外科，湖南长沙 410008
  • 出版日期:2016-11-01 发布日期:2016-10-27

  • Online:2016-11-01 Published:2016-10-27

摘要：

目的    观察微创腹膜后入路胰腺坏死组织清除术（MARPN）治疗感染性胰腺坏死（IPN）的临床疗效并总结经验。方法    回顾性分析2013年9月至2016年7月中南大学湘雅医院收治的18例采用MARPN治疗的IPN病人的临床资料，其中15例行经皮穿刺引流术+MARPN，3例为开放手术+MARPN。结果    18例病人胰周引流液培养结果均为多重病原菌感染。15例（83.3%）行MARPN后脓毒症完全逆转痊愈出院，1例因并发出血和肠瘘中转开放手术。术后发生胰瘘7例（38.9%）、肠瘘5例（27.8%）、出血2例（11.1%）。3例（16.7%）病人因继发出血或肠瘘，最终导致多器官功能衰竭而死亡。结论    采用以MARPN为重要方式的升阶梯或降阶梯治疗方案是治疗IPN的有效策略。

关键词: 重症胰腺炎, 感染性胰腺坏死, 微创腹膜后入路胰腺坏死组织清除术

Abstract:

Role of minimal access retroperitoneal pancreatic necrosectomy in the treatment of infected pancreatic necrosis: An analysis of 18 cases        HUANG Geng-wen，SHEN Ding-cheng，KANG Hao，et al.  Department of Bilio-Pancreatic Surgery，Xiangya Hospital，Central South University，Changsha 410008，China
Corresponding author: HUANG Geng-wen，E-mail: 1466471168@qq.com
Abstract    Objective    To summarize the role of minimal access retroperitoneal pancreatic necrosectomy (MARPN）in the treatment of infected pancreatic necrosis (IPN). Methods    The clinical data of 18 cases of IPN performed MARPN in Xiangya Hospital，Central South University between September 2013 and July 2016 were analyzed retrospectively.  All the cases included 15 cases treated with percutaneous catheter drainage plus MARPN and 3 cases with open drainage plus MARPN. Results    The culture of peripancreatic drainage in all  the 18 cases showed multiple microorganisms. The sepsis was completely reversed through MARPN in 15 cases（83.3%） and only 1 case converted to open surgical necrosectomy because of bleeding and intestinal leakage. The postoperative morbidity included 7 cases (38.9%) of pancreatic leakage，5 cases (27.8%) of intestinal leakage and 2 cases (11.1%) of bleeding. The overall mortality rate was 16.7% (3/18) and the underlying reasons for the mortality included bleeding and intestinal leakage，which led to multiple organ dysfunction syndrome. Conclusion    Step-up or step-down approach based on MARPN is an effective strategy to treat infected pancreatic necrosis.

Key words: severe acute pancreatitis, infected pancreatic necrosis, minimal access retroperitoneal pancreatic necrosectomy