重症急性胰腺炎各期经皮穿刺置管引流疗效

发布时间：2018-04-19 13:50

本文选题：重症急性胰腺炎 + 经皮穿刺置管引流　；参考：《安徽医科大学学报》2017年03期

【摘要】：目的探讨重症急性胰腺炎经皮穿刺置管引流治疗的时机及临床价值。方法回顾性分析采用经皮穿刺(置管)引流术治疗的125例重症急性胰腺炎病例资料。所有患者在CT及床边B超引导下行经皮穿刺引流术。结果首次穿刺引流时间距发病1~46(11.0±7.9)d,每例置管次数0~11次,平均3.2次,留置引流管时间0~128(27.1±16.6)d。共107例(107/125,85.6%)患者接受经皮穿刺(置管)引流或后期中转开腹手术治疗后康复,18例(18/125,14.4%)死亡。21例(21/117,17.9%)在行经皮穿刺置管引流后3~32(19.8±9.0)d接受开放手术治疗、16例(16/21,76.2%)最终获得治愈、5例(5/21,23.8%)死亡。穿刺置管引流总体有效率为70.9%(83/117),1周内为79.4%(27/34),1~2周为75.9%(22/29),2~4周为63.2%(24/38),4周后为62.5%(10/16);各阶段置管并发症发生例数分别为5、8、7、4(P=0.595);各阶段死亡例数为5(14.7%)、4(13.7%)、7(18.4%)、2(12.5%)(P=0.932)。结论在遵循指南的基础上,观察患者的临床表现、置管引流有效性等更为重要;早期穿刺置管引流的最终有效率较高,安全、不增加感染率,但差异无统计学意义;后期不排斥中转开放手术治疗,但指征需进一步探究。
[Abstract]:Objective to explore the opportunity and clinical value of percutaneous catheter drainage in severe acute pancreatitis.Methods 125 cases of severe acute pancreatitis treated by percutaneous puncture and drainage were retrospectively analyzed.All patients underwent percutaneous puncture and drainage under CT and bedside B-ultrasound guidance.Results the time of the first puncture drainage was 11 times (3.2 times) per case, and the time of the first puncture drainage was 0.12827.1 卤16.6d. the time of the first puncture was 11.0 卤7.9d from the onset of the disease, and the number of catheterization was 0.11 times (average 3.2 times).A total of 107 patients underwent percutaneous puncture (drainage) or late conversion to open surgery (18 / 18 / 125 / 14.4) died. 21 cases (21 / 117 / 17. 9) were treated with open surgery for 3 3219.8 卤9. 0 days after percutaneous catheterization. 16 patients (16 / 1621 / 76.2p) were cured and 522223.8had died.The overall effective rate of puncture and drainage was 70.9 / 83 / 117g / 1: 79.49.447 / 34 / 12 / 2 / 75.9 / 22 / 29 / 22 / 24.The total effective rate was 62.5 / 10 / 1616 after 24 / 23 / 24 / 38 / 4; the number of complications in each stage was 5 / 874P ~ (0.595); and the number of deaths at each stage was 57.713.713.714.4/ t = 413.718.4/ 42 / 212.5a / t = 0.932 / 10 / 16; the number of deaths at each stage was 413.713.718.4N / t and 0.932 / 10 / 10 / 10 / 10, respectively, and the number of deaths at each stage was 413.718.4t = 413.718.4B / t = 0.932 / 10 / 165.The total effective rate of catheterization and drainage in one week was 79.40.74%.Conclusion on the basis of following the guidelines, it is more important to observe the clinical manifestations of patients and the effectiveness of catheterization and drainage, the final effective rate of early puncture catheter drainage is higher, safety, no increase in infection rate, but the difference is not statistically significant.No rejection was transferred to open surgery at late stage, but the indications needed to be further explored.
【作者单位】：安徽医科大学第二附属医院普外科;安徽医科大学第二附属医院重症医学科;安徽医科大学第一附属医院肝胆胰外科;
【基金】：安徽省科技攻关项目(编号:1301042206)
【分类号】：R657.51

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