影像引导经皮穿刺置管灌洗引流在重症急性胰腺炎早期治疗中的应用

目的 探讨影像引导经皮穿刺置管灌洗引流在重症急性胰腺炎（SAP）早期治疗中应用的可行性、临床价值与技术特点.方法 选自我院2008年9月至2010年2月收治的SAP患者56例,随机分为影像引导下经皮穿刺置管灌洗引流治疗组（简称治疗组）（n=27）和常规保守治疗组（简称对照组）（n=29）,检测两组患者治疗前后的实验室指标,对比两组患者治疗后恢复情况及疗效.结果 治疗后两组患者血白细胞计数、血糖、血钙、血、尿淀粉酶等指标出现显著性差异（P＜0.05）,症状体征消失天数、恢复饮食天数、总住院天数等也均有显著性差异（P＜0.01）.治疗组死亡率明显低于对照组（7.4％vs.20.7％,P＜0.05）,有效率则高于对照组（88.9％vs.65.5％,P＜0.05）.结论 影像引导经皮穿刺置管灌洗引流是SAP早期治疗中一种安全可行的方法,其用微创的方法达到开腹手术全面探查、充分灌洗引流治疗SAP的目的,值得临床推广应用.

The value of image-guide percutaneous tube lavage and drainage in early treatment for severe acute pancreatitis

Objective To discuss the feasibility,clinical value and technical features of image-guided percutaneous tube lavaged and drainage in the early treatment of severe acute pancreatitis （SAP）.Methods 56 patients with severe acute pancreatitis in our hospital from September 2008 to February 2010 were randomly divided into two groups which were treated with image （ultrasonic or CT combined） guided percutaneous catheter lavage and drainage （n =27） and conservative methods respectively （control group） （n =29）.Laboratory data of both groups were obtained before and after treatment; recovery and efficacy after treatment were compared between these two groups;medical statistics analysis were made.Results After treatment,there were significant differences in white blood cell count,blood sugar,blood calcium and amylase in blood and urine between treatment group and control group （P＜0.05）,and there were significant differences （P ＜0.01） in the time of relief from abdominal pain,of resume eating days,duration,etc between these two groups.The mortality of treatment group were significantly lower than the control group（7.4％ vs.20.7％）.At the same time the cure rate of the former was higher than the latter （88.9％ vs.65.5％）.Conclusions Image-guide percutaneous tube lavage and drainage is feasible and safe for the early treatment of SAP.It can achieve the same results of complete exploration,sufficient peritoneal lavaged and drainage by laparotomy in a minimally invasive way.Thus it is worthy of popularization in clinical practice.