Abstract: Clinical study on distribution characteristics of infected pancreatic necrosis and therapeutic approach of laparoscopic surgery        CAO Feng，LI Ang，GAO Chong-chong，et al. Department of General Surgery ，Xuanwu Hospital，Capital Medical University；Clinical Center for Acute Pancreatitis，Capital Medical University，Beijing 100053，China
Corresponding author：LI Fei，E-mail：feili36@ccmu.edu.cn
Abstract    Objective    To explore the distribution characteristics of infected pancreatic necrosis（IPN）and therapeutic effect of minimally invasive surgery for IPN patients. Methods    The clinical data of IPN patients who treated in the department of qeneral surgery of xuanwu hospital from January 2013 to December 2018 was reviewed. The classification was proposed by analyzing the distribution characteristics of the infected effusion. According to different types，different surgical approaches were used and the clinical outcomes were recorded. Results    Totally，233 IPN patients were included in this study. A classification system of distribution characteristics was proposed as follows: type Ⅰ45 cases(19.3%)，type Ⅱa 21 cases(9.0%)，type Ⅰ+Ⅱa 82 cases(35.2%)，type Ⅲ 6cases(2.6%)，type Ⅰ+Ⅱa+Ⅱb 51cases(21.9%)，type Ⅰ+Ⅲ 11cases(4.7%)，type Ⅰ+Ⅱa+Ⅱb+Ⅲ 17 cases(7.3%). 177 patients received laparoscopic surgery，of these，49 cases used median approach，77 cases used left retroperitoneal approach，23 cases used median and left retroperitoneal approach，6 cases used median and right retroperitoneal approach，4 cases used right retroperitoneal approach，8 cases used bilateral retroperitoneal approach，6 cases used median and bilateral retroperitoneal approach，and 4 cases used transgastric approach. The overall mortality was 6.9%. In the initial surgery，the operation time was （73.5±16.2）min，estimated blood loss was 25(10-600)mL，and number of drainage tubes placed was 3.2±1.6. The mean number of operations was 2.0±1.6. The postoperative severe complication(Clavien-Dindo grade Ⅲ or higher) rate and mortality were 23.1% and 7.9%，respectively. Conclusion    Peripancreatic and left retroperitoneal spaces were the most common distribution areas of IPN. According to the distribution of necrotic infection，IPN can be safely and effectively treated by laparoscopic assisted debridement using different surgical approaches.

Key words: acute pancreatitis, infection, laparoscope, therapeutic approach

摘要： 目的    分析感染性胰腺坏死（IPN）的分布特点及微创治疗效果。方法    回顾性分析2013年1月至2018年12月首都医科大学宣武医院普通外科治疗的IPN病人的临床资料，分析感染积液区域的分布特点，提出分区分型。根据不同分型采用不同微创手术入路，观察手术疗效。结果    共纳入233例IPN病人，其坏死积液区分布为：Ⅰ区45例（19.3%），Ⅱa区21例（9.0%），Ⅰ+Ⅱa区82例（35.2%），Ⅲ区6例（2.6%），Ⅰ+Ⅱa+Ⅱb区51例（21.9%），Ⅰ+Ⅲ区11例（4.7%），Ⅰ+Ⅱa+Ⅱb+Ⅲ区17例（7.3%）。177例病人接受腹腔镜手术治疗，其中正中入路手术49例，左侧腹膜后入路77例，正中联合左侧腹膜后入路23例，正中联合右侧腹膜后入路6例，右侧腹膜后入路4例，双侧腹膜后入路8例，正中联合双侧腹膜后入路6例，经胃入路4例。病人总体病死率6.9%。接受手术病人初次手术时间为（73.5±16.2）min，估计出血量为25（10~600）mL，留置引流管数量为（3.2±1.6）个，手术次数（2.0±1.6）次。术后Clavien-Dindo 分级≥Ⅲ级并发症发生率为23.1%，手术后病死率为7.9%。结论    胰周及左侧腹膜后是IPN最常见的分布区域。根据坏死感染分布范围的不同，选择不同入路行腹腔镜辅助胰腺坏死组织清除可安全、有效治疗IPN。

关键词: 急性胰腺炎, 感染, 腹腔镜, 手术入路