重症急性胰腺炎的腹腔镜治疗:手术时机及手术方式探讨

目的探讨腹腔镜治疗重症急性胰腺炎(severeacutepancreatitis,SAP)的手术时机、方法及疗效。方法腹腔镜下分离胃结肠韧带,进入网膜腔暴露胰腺,清除渗出液、浓液,通畅脓腔分隔,但不必进行彻底的胰腺坏死组织清创。网膜囊及盆腔置入灌洗管和多根引流管,术后用大量生理盐水持续灌洗引流至引出的灌洗液澄清,并急性肾功能衰竭病人同时盆腔内置入腹膜透析管行腹膜透析。选择腹腔镜手术时间为发病后18h￣26d不等。结果治愈17例,1例死于多器官功能衰竭,住院时间28￣86d,平均46d。结论采用腹腔镜治疗重症急性胰腺炎对机体的创伤打击小、干扰少,冲洗引流可靠,可有效地改善重症急性胰腺炎的预后,是现行一种安全有效的治疗方法。其手术时机、适应证的选择与传统开腹手术有所不同。

Laparoscopic treatment of severe acute pancreatitis: Time, indications and procedure of surgery

Obstractive] To evaluate the time, procedures and treatment effects for severe acute pancreatitis(SAP)under laparoscopy. Methods] The gastrocolic ligament was opened under laparoscopy. The pancreas was then accessed and exposed clearly, removing all exudations and pus, opening up the undrained loculi placement. It was unnecessary to perform a complete debridement of all necrosis tissue. Drainage and irrigating catheters were placed around the pancreas and pelvic cavity. Large volumes of normal saline were used to lavage until the abdominal fluid became clear. Patients with acute renal failure were treated with peritoneal dialysis in the same time. The time from onset of the disease to operation varied from 18 hours to 26 days. Results] 17 patients recovered completely and 1 patient died due to multi-system organ failure. The length of postoperative hospital stay was 28 to 86 days and mean hospital stay was 46 days. Conclusions] The laparoscopic treatment in severe pancreatitis appears to be a safe and effective approach, with minimally invasive and interfering, efficient in drainage and improvement in the patients' prognosis. The time and indications of surgical intervention are different from the conventional operation.