胆道镜经引流窦道清创技术治疗胰周脓肿

目的评价胆道镜经引流窦道清创治疗胰周脓肿的疗效。方法2008年1月～2011年12月，对81例开腹清创引流或超声引导穿刺引流未愈的胰周脓肿，胆道镜经引流窦道进入病灶内部，以活检钳和取石网钳取脓苔及坏死脱落组织，生理盐水灌洗脓腔，反复清创和持续引流，达到治愈。结果治愈76例，治愈率93．8％。4例因CT显示坏死区域靠近肠系膜血管或脾门部位改行开腹手术，1例因并发严重多器官功能衰竭死亡。76例治愈者接受胆道镜清创2—9次，平均5．1次，第一次镜下清创至治愈拔管时间25～132d，平均37d。胆道镜清创并发出血2例，肠漏1例，保守治愈。76例治愈患者随访3～38个月，其中〉12个月39例，无病灶残余。结论胆道镜完成对胰周脓肿病灶的清创，方法简单，临床效果可靠。

Choledochoscopic-assisted Debridement for Peripancreatic Abscess through a Draining Sinus

Objective To assess the effect of choledochoscopy for the treatment of peripancreatic abscess. Methods From January 2008 to December 2011, totally 81 patients, who had unhealed peripancreatic abscess after open surgery or ultrasonography- guided puncture for drainage, underwent choledochoscopic-assisted debridement via a draining sinus in our hospital. After removing pus and necrotic tissues with biopsy forceps and basket extraction, we carried out irrigation of the abscess cavity with physiological saline and then repeated debridement and continuous drainage until the lesion was healed. Results Of the 81 patients, 76 were cured （ success rate ： 93.8% ） ; 4 patients were converted to an open surgery because of a necrotic lesion close to the mesenteric vessels or porta lienls shown by CT; one patient died of multiple organ failure. The 76 cured patients received 2 - 9 times of choledochoscopie- assisted debridement with a mean of 5.1 times. And the mean duration from the first debridement to removing drainage tube was 37 days （ranged from 25 to 132 days）. Among the cases, two developed hemorrhage and one showed intestinal leakage, all of them were then cured by conservative therapies. The 76 patients were followed up for 3 to 38 months （ 〉 12 months in 39 patients）. No residual lesions were detected. Conclusion Choledoehoscopy is a simple, reliable and effective approach for debridement of peripancreatic abscess.