中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (05): 381-383.

• 论蓍 • 上一篇    下一篇

重症急性胰腺炎的围胰腺区域分步微创治疗

范应方，方驰华，项    楠，杨    剑，郝建志   

  1. 南方医科大学珠江医院肝胆一科，广东广州 510282
  • 出版日期:2010-05-01 发布日期:2010-05-06

  • Online:2010-05-01 Published:2010-05-06

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摘要：

 目的    观察围胰腺区域分步微创治疗重症急性胰腺炎（SAP）的临床疗效。方法    2003年9月至2009年10月南方医科大学珠江医院肝胆一科对收治的36例SAP病人入院后在实施内科药物治疗同时，立即行局麻下腹部小切口于胰腺上下缘置入腹腔双套管，采用5?FU生理盐水持续滚动冲洗；合并化脓性胆管炎者同时行Oddi括约肌切开取石术（EST）或鼻胆管引流（ENBD）。合并胆囊结石者二期行腹腔镜胆囊切除术(LC)，合并胆囊结石和胆总管结石者二期行LC加胆总管切开取石或EST。结果    经围胰腺区域微创置管冲洗引流1周后，SAP病人腹腔引流液淀粉酶含量、血淀粉酶含量及白细胞等显著下降（t=2.68，P=0.013；t=2.41，P=0.028；t=2.32，P=0.035）。36例病人全程微创治疗成功，好转率100%，治愈率94.44%，病死率为0。结论    围胰腺区域分步微创治疗SAP疗效显著，术后并发症发生率低，值得临床推广应用。

关键词: 重症急性胰腺炎, 胰腺区域, 微创

Abstract:

Step by step treatment around pancreatic region with minimally invasive surgery for severe acute pancreatitis  FAN Ying-fang，FANG Chi-hua，XIANG Nan，et al. Department of Hepatobiliary SurgeryⅠ，Zhujiang Hospital of Southern Medical University，Guangzhou 510282，China
Corresponding author:FANG Chi-hua，E-mail：fangch_dr@126.com
Abstract    Objective    To investigate the clinical effect of step by step minimally invasive surgery around pancreat region for patients with severe acute pancreatitis（SAP）. Methods    Thirty-six patients with SAP admitted between September 2003 and October 2009 at the Department of Hepatobiliary SurgeryⅠ，Zhujiang Hospital of Southern Medical University were performed medical treatment. At the same time, patiens were also given minimally invasive treatments step by step. step1：With local anesthesia，patients were put the home-made double drainage tube in peritoneal cavity around the region of pancreas, and patiens with acute suppurative cholangitis (ASC) also performed by emergency surgery such as endoscopic sphincterotomy (EST) or endoscopic nasobiliary drainage (ENBD). Through double drainage tube, all patient’s cavity was persistently douched using 0.5% 5-FU saline solution. step2：After the symptoms of SAP was controlled, patients with biliary stone were performed by laparoscopically operations including laparoscopic cholecystectomy(LC), laparoscopic common bile duct lithotomy, EST, etc. Results    All 36  SAP patients  were performed with full of minimally invasive therapy successfully. Patient’s drainage fluid amylase concentration, blood amylase concentration and leukocytes were decreased significantly after one week（t=2.68, P=0.013；t=2.41, P=0.028；t=2.32, P=0.035）. The cure rate, improvement rate and mortality rate of 36 cases was 94.44%, 100% and zero respectively. Conclusion    Step by step minimally invasive surgical treatment around pancreatic region for SAP have many advantages including minimally invasive, few complications and significant effect. The therapeutic schedule should have potential value for clinical application.

Key words: severe acute pancreatitis(SAP), pancreatic region, minimally invasive