B 超引导下经皮穿刺置管引流治疗重症急性胰腺炎局部并发症

目的:探讨B超引导下经皮穿刺置管引流(PCD)治疗重症急性胰腺炎(SAP)局部并发症的临床价值。方法:回顾分析2006年1月—2009年10月行B超引导下PCD治疗SAP局部并发症的42例患者的临床资料,其中急性液体积聚14例,无菌性胰腺坏死12例,感染性胰腺坏死9例,包裹性坏死感染1例,胰腺脓肿4例,胰腺假性囊肿2例。并检查穿刺液是否伴感染,观察引流后临床症状、引流效果和影像学的改变。结果:42例中,14例急性液体积聚均治愈(100%),但有2例发生胰周感染,1例出现肠外瘘,无死亡;无菌性胰腺坏死12例中治愈9例(75.0%),3例发生胰腺感染并手术,死亡1例;感染性胰腺坏死9例中治愈2例(22.2%),4例引流效果差而手术,死亡2例,3例放弃治疗;包裹性坏死感染1例PCD后囊内出血急诊手术后死亡;4例胰腺脓肿治愈1例(25.0%),3例中转手术,无死亡。2例胰腺假性囊肿分别于第1,2个月后治愈拔管。结论:B超引导下PCD便捷安全,在治疗SAP不同局部并发症中有着不同的意义。对部分SAP局部并发症,B超引导下PCD可避免传统外科干预。

B ultrasound-guided percutaneous catheter drainage for local complications of severe acute pancreatitis

Objective: To assess the clinical efficacy of B ultrasound-guided percutaneous catheter drainage(PCD) for local complications of severe acute pancreatitis(SAP). Methods: The clinical data of 42 SAP patients with local complications undergoing B ultrasound-guided PCD from January 2006 to October 2009 in our hospital were retrospectively analyzed.Of the patients,14 cases were complicated with acute fluid collection,12 cases with sterile pancreatic necrosis,9 cases with infected pancreatic necrosis,4 cases with pancreatic abscess,1 case with encysted infected necrosis and 2 cases with pancreatic pseudocysts.Microbiological examination was performed to determine whether the puncture fluid was associated with infection or not,and the clinical symptoms,drainage effect and imaging changes after PCD were observed. Results: Of the 42 patients,the 14 cases with acute fluid collection were all cured,but 2 of them developed peripancreatic infection and one case had an enterocutaneous fistula,but no death occurred;in the 12 cases with sterile pancreatic necrosis,9 cases were cured(75%),3 cases developed pancreatic infection and then underwent operation,1 of whom died;in the 9 cases with infected pancreatic necrosis,2 cases were cured and 4 cases underwent operation due to poor drainage,2 of whom died and 3 declined treatment;the single case with encysted infected necrosis developed intracystic bleeding after PCD and died after emergency surgery;in the 4 cases of pancreatic abscess,1 case was cured,3 cases were converted to operation and no death occurred;the 2 cases with pancreatic pseudocysts were successfully drained and the catheters were removed 1 and 2 months later,respectively. Conclusion: B ultrasound-guided PCD is a safe and easily handled procedure,and it plays various roles in treating different SAP local complications.It avoids conventional surgical intervention for certain patients.