重症急性胰腺炎合并胰腺周围大量积液的不同处理

目的:探讨重症急性胰腺炎(SAP)合并胰腺周围大量积液不同处理方式的疗效。方法:回顾性分析2008年10月—2016年5月收治的162例SAP合并胰腺周围大量积液患者的临床资料,其中68例行保守治疗(保守治疗组),67例行超声或CT引导下经皮穿刺置管引流治疗(穿刺引流组),13例行腹腔镜手术治疗(腹腔镜组),14例行开腹手术治疗(开腹组),比较各组的相关临床指标。结果:各组一般资料具有可比性;穿刺引流组与腹腔镜组症状体征消失时间、血淀粉酶恢复正常时间均明显短于保守治疗组,保守治疗组腹腔内积液大体吸收时间、膀胱压下降时间明显晚于其余各组(均P0.05);穿刺引流组与腹腔镜组住院时间明显短于保守治疗组与开腹组,并发症发生率也明显低于保守治疗组与开腹组(均P0.05);保守治疗组的治疗有效率明显低于其余各组,再手术率明显高于其余各组(均P0.05);保守治疗组与开腹组病死率明显高于穿刺引流组与腹腔镜组(均P0.05)。结论:B超或CT引导下穿刺及腹腔镜后入路置管引流对治疗SAP合并胰腺周围大量积液疗效较好,且并发症发生率与病死率较低。

Comparison of different treatment methods for severe acute pancreatitis with massive peripancreatic fluid collections

Objective: To investigate different treatment methods of SAP with massive peripancreatic fluid collections. Methods: The clinical data of 162 patients with SAP and concomitant massive peripancreatic fluid collections treated during October 2008 to May 2015 were retrospectively analyzed. Of the patients, 68 cases underwent conservative treatment (conservative treatment group), 67 cases underwent ultrasound or CT guided percutaneous puncture and catheter drainage (puncture drainage group), 13 cases underwent laparoscopic surgery (laparoscopic group) and 14 cases underwent traditional open surgery (laparotomy group). The relevant clinical variables among groups were compared.Results: The general data of the four groups were comparable. The times for disappearance of symptoms and for recovery of serum amylase in puncture drainage group and laparoscopic group were significantly shorter than those in conservative treatment group, and the times for most abdominal effusion absorption and bladder pressure decrease in conservative treatment group were significantly later than those in the other three groups (all P<0.05). In puncture drainage group or laparoscopic group, the length of hospital stay was significantly shorter and incidence of complications was significantly lower than those in conservative treatment group or laparotomy group (all P<0.05). The effective success rate was significantly lower and re-operation rate was significantly higher in conservative treatment group than those in the other three groups (all P<0.05). The mortality rates were significantly increased in conservative treatment group and laparotomy group compared with puncture drainage group or laparoscopic group (all P<0.05).Conclusion: Ultrasound or CT guided percutaneous puncture and catheter drainage or catheter drainage via laparoscopic retroperitoneal approach has demonstrable efficacy in treatment of SAP with massive peripancreatic fluid collections, with advantages of low incidence of complications and mortality rates.