重症急性胰腺炎并发胰腺感染坏死和胰腺脓肿的诊断和治疗

目的探讨胰腺感染坏死（IPN）和胰腺脓肿（PA）的诊断和治疗。方法对1990年1月至2003年4月收治的33例IPN和6例PA的诊断和治疗效果进行回顾性分析。结果33例IPN患者,28例行开腹清创引流,5例行经后腹膜途径清创引流,1例因为合并腹腔间隔室综合征和多脏器功能衰竭死亡,2例合并胰瘘、肠瘘,出血死亡,30例痊愈出院。6例PA患者,4例行经皮穿刺抽吸置管引流,后因引流不畅中转开腹,2例直接行脓肿切开引流,6例患者均痊愈出院。结论B超和CT联合检查和动态观察,对诊断IPN和PA有重要价值;对于IPN,应采取延迟手术干预的策略;对于PA,应行脓肿切开引流。

The diagnosis and management of infected pancreatic necrosis and pancreatic abscess in patients with severe pancreatitis

Objective To study the diagnosis and treatment of infected pancreatic necrosis (IPN) and pancreatic abscess ( PA ). Methods We retrospectively analyzed the diagnosis, treatment and outcome of 33 IPN and 6 PA patients from January 1990 to April 2003. Results Among 33 IPN patients, 28 underwent transperitoneal debridement and drainage, 5 underwent retroperitoneal debridement and drainage. One patient died of abdominal compartment syndrome ( ACS) and multiple organ dysfunction syndrome (MODS) , 2 died of pancreatic fistula, intestines fistula and bleeding, 30 of them were cured. Among 6 PA patients, four patients underwent tube drainage by percutaneous puncture and consequential open surgery due to poor drainage, 2 patients underwent open drainage, all were cured. Conclusions B ultrasound and CT examination and dynamic observation play an important role for the diagnosis of IPN and PA. Delayed surgical intervention should be adopted when the diagnosis of IPN is established. Open drainage should be performed for PA.