上腹联合侧腹入路胰腺坏死感染组织清除术治疗后腹膜感染的疗效评估

目的比较上腹和侧腹联合入路手术方式与常规上腹入路的胰腺坏死感染组织清除术对重症急性胰腺炎后腹膜感染的疗效。方法回顾性分析西京医院2006年1月-2011年12月既往无基础脏器功能障碍的76例重症急性胰腺炎手术患者临床资料。其中36例行上腹和侧腹联合入路，40例行传统上腹入路。比较两组入选患者的一般资料、手术后并发症、新发多脏器功能衰竭、病死率等。结果两组比较结果显示，传统上腹部入路组与上腹联合侧腹入路组患者术后局部并发症差异无统计学意义，上腹联合侧腹入路组术后器官功能衰竭发病率（3／36 vs 11／40，P=0．031）、再次手术干预率（10／36 vs 22／40，P=0．016）和病死率（4／36 vs 12／40，P=0．044）均低于传统上腹部入路组。结论上腹联合侧腹入路胰腺坏死组织清除术是胰腺炎引起的后腹膜感染有效治疗方法，能够有效降低患者术后新发器官功能衰竭、再次手术干预率及病死率。

Retroperitoneal combined upper abdominal approach improves out- corns of infected pancreatic necrosis

Objective To compare the efficacy of retroperitoneal combined upper abdominal （RCUA） approach and traditional upper abdominal （UA） approach in treating infected （peri）pancreatic necrosis. Methods All patients received open surgery for infected pancreatic necrosis during January 2006 to December 2011 in Xijing hospital were retrospectively studied. Patients were divided into RCUA and the UA group by the surgical approach they had received. Seventy-six patients were included in this study. Of them, 36 patients received the RCUA approach and 40 patients received the UA approach. The demographic characteristic, operation complications and mortality were compared between the two groups. Results The incidence of local complications was similar between the two groups. Compared with UA group, RCUA group had lower incidence of postoperative new-onset multiple organ failure （3/36 vs 11/40, P = 0. 031 ）, lower rate of reintervention （10/36 vs 22/40, P = 0. 016） and mortality （4/36 vs 12/40, P =0. 044）. Conclusions Compared with the traditional UA approach, RCUA approach reduces the incidence of postoperative newonset multiple organ failure, the rate of reintervention and mortality.