彩超引导下穿刺置管引流术治疗重症急性胰腺炎并积液的疗效研究

目的：探讨彩超引导下穿刺置管引流术治疗重症急性胰腺炎（SAP）并腹腔积液的临床疗效。 方法：收集131例SAP且病程中确定存在液体（II型）腹腔高压患者的临床资料，其中65例行超声引导下经皮穿刺置管引流冲洗治疗（观察组），66例行保守治疗（对照组）。比较两组患者相关临床指标、疗效评价指标、并发症发生率及病死率。 结果：两组患者治疗前一般资料具有可比性。观察组患者在症状体征消失时间、血淀粉酶恢复正常的时间、恢复饮食的天数及总住院天数等疗效指标上均优于对照组（均P<0.05）；两组治疗后膀胱压均呈下降趋势，但观察组膀胱压下降速度较对照组快（P<0.05）；观察组并发症发生率低于对照组，治疗有效率高于对照组（均P<0.05）；两组患者病死率差异无统计学意义（P>0.05）。 结论：早期腹腔穿刺引流可以降低SAP并腹腔积液患者的腹腔内压力，缩短病程，降低并发症发生率，但未能明显降低病死率。

Percutaneous catheter drainage under guidance of Color Doppler ultrasound in treatment of severe acute pancreatitis with abdominal fluid collections

Objective: To investigate the clinical efficacy of percutaneous catheter drainage (PCD) under the guidance of Color Doppler ultrasound in treatment of severe acute pancreatitis (SAP) with abdominal fluid collections. Methods: The clinical data of 131 SAP patients with confirmed fluid induced (type II) intra-abdominal hypertension during the course of SAP were collected. Of the patients, 65 cases underwent ultrasound-guided PCD (observational group), while the other 66 cases underwent conservative treatment (control group). The relevant clinical variables, efficacy indexes, and incidence of complications and mortality between the two groups were compared. Results: The pre-treatment data between the two groups were comparable. Observational group was superior to control group with regard to the time to disappearance of symptoms and signs, to blood amylase level recovery, and to diet resumption as well as the length of total hospital stay (all P<0.05). The urinary bladder pressure in both groups showed a decreased trend after treatment, but the decreasing speed in observational group was faster than that in control group (P<0.05). The incidence of complications was reduced and the effective rate of treatment was increased in observational group compared with control group (both P<0.05). There was no statistical difference in mortality between the two groups (P>0.05). Conclusion: Early PCD can reduce the abdominal pressure in SAP patients with abdominal fluid collections, decrease the incidence of complications and shorten the course of disease, but it has no significant effect on mortality.