电极片定位超声引导下经皮穿刺置管引流治疗感染性胰腺坏死:附61例报告

发布时间：2018-05-01 04:35

本文选题：胰腺炎 + 急性坏死性　；参考：《中国普通外科杂志》2017年09期

【摘要】：目的:总结电极片定位超声引导下经皮穿刺置管引流(PCD)治疗感染性胰腺坏死(IPN)的经验。方法:回顾性分析2010年10月—2016年12月间61例采用电极片定位超声引导下PCD治疗的IPN的临床资料。结果:全组61例均顺利施行PCD。23例(37.7%)仅行PCD治疗,22例(36.1%)经PCD治疗后中转微创腹膜后入路胰腺坏死组织清除术(MARPN),16例(26.2%)患者经PCD治疗后中转开腹胰腺坏死组织清除术(OPN)。全组病死率24.6%(15/61),包括仅行PCD治疗6例、中转MARPN者4例和中转OPN者5例。PCD术后并发症36例次,包括12例次出血,15例次胰瘘,9例次肠瘘。穿刺引流液培养结果包括单菌种感染19例(31.1%)和多重感染42例(68.9%),其中多重耐药菌(MDRO)感染38例(62.3%)。与患者死亡有关的因素包括2012版急性胰腺炎严重程度分级、外科干预后脓毒症是否逆转、穿刺并发出血以及MDRO感染(均P0.05)。结论:电极片定位超声引导下PCD是一种相对简便安全的胰周穿刺引流方法,以此为基础的"升阶梯"治疗策略是治疗IPN的有效策略。
[Abstract]:Objective: to summarize the experience of percutaneous percutaneous catheter drainage (PCD) guided by electrode localization in the treatment of infective pancreatic necrosis (IPN). Methods: the clinical data of 61 cases of IPN treated with PCD guided by electrode film were analyzed retrospectively from October 2010 to December 2016. Results: all 61 cases were treated successfully with PCD.23 (37.7%) and only 22 cases (36.1%) were treated with PCD. After PCD treatment, 16 cases (26. 2%) were transferred to minimally invasive retroperitoneal approach for pancreatic necrotic tissue clearance. The patients were converted to open pancreatic necrotizing tissue clearance after PCD treatment. The fatality rate of the whole group was 24.66.15 / 61%, including 6 cases treated with PCD only, 4 cases with intermediate MARPN, and 36 cases with complications after OPN, including 15 cases of pancreatic fistula and 9 cases of intestinal fistula, including 12 cases of hemorrhage and 15 cases of pancreatic fistula. The results of puncture and drainage fluid culture included single strain infection (19 cases, 31. 1) and multiple infection (42 cases, 68.9%). Among them, 38 cases were infected with multidrug resistant bacteria (MDR). Factors associated with death included the severity of acute pancreatitis in version 2012, the reversal of sepsis after surgical intervention, puncture with bleeding, and MDRO infection (all P 0.05). Conclusion: PCD is a relatively simple and safe method of peripancreatic puncture and drainage under the guidance of ultrasound guided by electrode plate. The "ascending ladder" therapy strategy based on this method is an effective strategy for the treatment of IPN.
【作者单位】：中南大学湘雅医院胰胆外科;中南大学湘雅医院重症医学科;
【基金】：中南大学湘雅医院管理研究基金资助项目(2016GL12)
【分类号】：R576

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