内镜清创术与外科清创术治疗胰腺坏死感染的回顾性研究

目的 评估内镜清创术与外科清创术两种方法治疗胰腺坏死感染的临床疗效.方法 回顾2009年6月至2016年6月新桥医院消化科内镜中心完成的胰腺坏死感染内镜清创术患者34例为内镜组,以同时期西南医院和大坪医院完成的胰腺坏死感染外科清创术的患者34例为外科组,分析比较其临床特征和治疗效果.结果 两组手术成功率均为100％;内镜组的病死率为8.82％(3/34),显著低于外科组41.18％ (14/34) (P ＜0.01);内镜组并发症发生率11.76％(4/34),显著低于外科组67.65％(23/34) (P＜0.01);两组并发症主要为出血、器官衰竭和休克,分别为2.94％(1/34)和61.76％(21/34)、0％(0/34)和41.18％(14/34)、2.94％ (1/34)和47.06％ (16/34),内镜组主要并发症发生率低于外科组(P＜0.01);两组复发率均为8.82％ (3/34);内镜组的手术次数、住院时间、住院费用均高于外科组,分别为2.62(1 ～10)次和1.06(1～2)次(P＜0.01)、83.5(7 ～175)d和54.2(2 ～ 154) d(P＜0.05)、35.18(2.81 ～147.61)万元和21.84(3.33 ～74.27)万元(P＜0.01).结论 胰腺坏死感染内镜清创术的并发症和病死率显著低于外科清创术,内镜清创术的手术次数、住院时间和住院费用均高于外科手术.

Efficacy of endoscopic and surgical necrosectomy for infected pancreatic necrosis: a retrospective study of 68 cases

Objective To evaluate the clinical efficacy of endoscopic and surgical necrosectomy in the treatment of infected pancreatic necrosis.Methods A retrospective study was conducted among 34 patients with infected pancreatic necrosis treated by endoscopic necrosectomy in the Endoscopy Center of Xinqiao Hospital from June 2009 to June 2016 and 34 patients treated by surgical necrosectomy in Southwest Hospital and Daping Hospital during the same period.The clinical characteristics and outcomes of the patients were compared between the 2 groups.Results The success rate of operation were 100％ in both groups.The mortality rate was 8.82 ％ in the endoscopic group,significantly lower than that of the surgical group (41.18％,P ＜ 0.01).The endoscopic group also had an obviously lower incidence of complications than the surgical group 11.76％ (4/34) vs 67.65％ (23/34),P ＜ 0.01].Bleeding,organ failure and shock were the main complications,whose incidences were 2.94％ (1/34),0 (0/34) and 2.94％ (1/34) in the endoscopie group,and 61.76％ (21/34),41.18％ (14/34) and 47.06％ (16/34) in the surgieal group,respectively (P ＜ 0.01).The recurrence rate was 8.82％ in both groups.The patients in the endoscopic group had more times of operations (2.62 vs 1.06 times,P ＜ 0.01),longer length of hospital stay (83.5 vs 54.2 d,P ＜0.05) and higher hospitalization cost (351 800 vs 218 400 Yuan,P ＜0.01) than those in the surgical group.Conclusion Compared with conventional surgical treatment,endoscopic necrosectomy can reduce the mortality rate and lower the incidence of complications for treatment of infected pancreatic necrosis,but is associated with more times of operations,a longer of hospital stay and a higher hospitalization cost.