摘要
目的探讨重症急性胰腺炎经皮穿刺置管引流治疗的时机及临床价值。方法回顾性分析采用经皮穿刺(置管)引流术治疗的125例重症急性胰腺炎病例资料。所有患者在CT及床边B超引导下行经皮穿刺引流术。结果首次穿刺引流时间距发病1~46(11.0±7.9)d,每例置管次数0~11次,平均3.2次,留置引流管时间0~128(27.1±16.6)d。共107例(107/125,85.6%)患者接受经皮穿刺(置管)引流或后期中转开腹手术治疗后康复,18例(18/125,14.4%)死亡。21例(21/117,17.9%)在行经皮穿刺置管引流后3~32(19.8±9.0)d接受开放手术治疗、16例(16/21,76.2%)最终获得治愈、5例(5/21,23.8%)死亡。穿刺置管引流总体有效率为70.9%(83/117),1周内为79.4%(27/34),1~2周为75.9%(22/29),2~4周为63.2%(24/38),4周后为62.5%(10/16);各阶段置管并发症发生例数分别为5、8、7、4(P=0.595);各阶段死亡例数为5(14.7%)、4(13.7%)、7(18.4%)、2(12.5%)(P=0.932)。结论在遵循指南的基础上,观察患者的临床表现、置管引流有效性等更为重要;早期穿刺置管引流的最终有效率较高,安全、不增加感染率,但差异无统计学意义;后期不排斥中转开放手术治疗,但指征需进一步探究。
Objective To explore the timing and clinical value of percutaneous catheter drainage in the treatment of severe acute pancreatitis（SAP）. Methods The clinical data of 125 consecutive patients with SAP treated with per- cutaneous puncture （catheter） drainage between January 2008 to October 2015 in the First Affiliated Hospital and Second Affiliated Hospital of Anhui Medical University were retrospectively analyzed （ 81 cases in the First Affiliated Hospital,44 cases in the Second Affiliated Hospital）. All pereutaneous puncture and drainage were guided by CT or bedside ultrasound. Results The time between the first percutaneous catheter drainage and the disease onset was 1 - 46 （ 11.0 ± 7.9） days, number of catheter per patient from 0 to 11, an average of 3.2. Indwelling drainage tube time was 0 -128（27.1 ± 16.6） days. A total of 107 cases （107/125,85.6%） of patients were rehabilitated after percutaneous （catheter） drainage or late conversion to open surgical treatment, 18 cases（ 18/125,14.4% ） died; 21 cases （21/117,17.9%） received open percutaneous necrosectomy after percutaneous catheter drainage 3 32 （ 19. 8 ± 9.0） days, 16 cases （ 16/21,76.2% ） obtained cured finally, 5 cases （5/21,23.8%） died. The o- verall efficiency rate of percutaneous catheter drainage was 70. 9% （83/117）, the efficiency rate of percutaneous catheter drainage within one week after onset was 79.4% （27/34）, 1 - 2 weeks was 75.9% （22/29）, 2 - 4 weeks was 63.2% （24/38）, and after 4 weeks was 62.5% （10/16）. The number of cases with complications of phases of percutaneous catheter drainage as follows ： 5 cases, 8 cases, 7 cases, 4 cases （P = 0. 595 ）. Number of deaths for phases of percutaneous catheter drainage was 5 cases （14. 7%）, 4 cases （13.7%）, 7 cases （ 18.4% ）, 2 cases （ 12.5 % ） （P --0. 932）. Conclusion On the basis of following guidelines, the clinical mani- festations of patients and effectiveness of drainage is more important in the choice of timing. Early drainage has more efficiency for ultimately efficacy. It is safe and does not increase infection rate, but the difference is not statis- tically significant. The treatment does not exclude the open surgery in the later period, but indications of conversion need to be explored further.
出处
《安徽医科大学学报》
CAS
北大核心
2017年第3期421-425,共5页
Acta Universitatis Medicinalis Anhui
基金
安徽省科技攻关项目(编号:1301042206)
关键词
重症急性胰腺炎
经皮穿刺置管引流
时机
severe acute pancreatitis
percutaneous catheter drainage
timing
