重症急性胰腺炎CT多平面重建指导腹腔镜置管引流的临床研究

发布时间：2018-04-01 20:28

本文选题：重症急性胰腺炎　切入点：CT多平面重建　出处：《南方医科大学》2017年硕士论文

【摘要】：背景:重症急性胰腺炎(SAP)是一种起病急骤,病情凶险多变,并发症及死亡率较高的急腹症。腹腔镜下置管腹腔灌洗引流(LPLD)通过清除胰周坏死组织及积液,减少胰酶吸收,降低炎症反应,显著降低多器官功能衰竭的发生率和病死率。但SAP患者早期胰周组织水肿粘连,解剖结构不清,术中易出血及引起严重并发症。因此,目前国内外专家对SAP患者早期行LPLD仍存在争议,如何提高早期腹腔镜手术治疗SAP的安全性和有效性仍需不断探索。CT检查SAP敏感性高,是SAP检查的首选。SAP的CT表现与临床严重程度相关,是LPLD术前评估的重要依据。术前通过CT对胰周情况的评估,有利于术中胰腺坏死组织清除及胰周精准置管。普通CT的平面图像,对准确判断胰腺坏死区域、胰周积液分布及周围血管的关系存在困难,使手术时间延长,风险增加。CT多平面重建通过对平面图像的识别、重组,重建与胰腺及周围相近的立体图像,对胰腺坏死区域、胰周积液分布及周围血管的关系评估更精确,对选择最佳手术入路、缩短手术时间、减小手术损伤、提高胰腺坏死病灶清除率及保证术后引流效果有重要的临床意义,国内外未见相关的研究报道。目的1、探讨重症急性胰腺炎早期腹腔镜置管引流手术的临床治疗效果。2、探讨重症急性胰腺炎CT多平面重建指导腹腔镜置管引流手术的临床应用。方法第一部重症急性胰腺炎早期腹腔镜置管引流手术的临床疗效分析。回顾性分析我院2007年1月至2014年12月54例行腹腔镜手术置管引流的重症急性胰腺炎患者的临床资料,观察临床疗效;对手术前后的CT改变进行分析,观察CT改变与临床疗效的关系。第二部分重症急性胰腺炎CT多平面重建指导腹腔镜置管引流的临床应用。前瞻性对2015年1月至2016年12月14例SAP患者行CT多平面重建,指导行腹腔镜置管引流手术,与2013年1月至2014年12月16例常规CT检查组的SAP患者进行比较,探讨CT多平面重建指导腹腔镜置管引流的临床价值。结果1、治愈50例,4例死亡,死亡率7.4%,1例死于合并胰腺癌,1例死于多器官功能衰竭,2例死于迟发腹腔大出血,平均住院时间(38.7+24.6)d。术后CT提示胰腺坏死残留及胰周感染12例,1例再次手术,2例迟发腹腔出血死亡。通过术前与术后CT改变比较显示,术后胰腺坏死残留及胰周感染的患者住院时间延长,差异有统计学意义(P0.05)。2、CT多平面重建与CT常规扫描组比较,手术时间短、出血量少、术后住院天数少,差异有统计学意义(P0.05)。结论1、早期腹腔镜置管引流手术治疗SAP是一种安全、有效的治疗手段。2、早期腹腔镜置管引流手术后胰腺坏死残留及胰周感染是SAP患者住院时间延长并产生严重并发症的主要原因。3、重症急性胰腺炎CT多平面重建指导腹腔镜置管引流可提高手术的安全性和有效性。
[Abstract]:Background: severe acute pancreatitis (SAP) is a kind of acute abdomen with acute onset, severe and changeable condition, high complications and high mortality. LPLD can reduce trypsin absorption by removing peripancreatic necrotic tissue and effusion. The incidence and mortality of multiple organ failure were significantly reduced in patients with SAP. However, the early peripancreatic tissue edema and adhesion, unclear anatomical structure, bleeding and serious complications occurred in the early stage of SAP. At present, experts at home and abroad still have controversy about early LPLD in patients with SAP. How to improve the safety and effectiveness of early laparoscopic surgery for SAP still needs to explore continuously the sensitivity of CT examination for SAP. The CT findings of SAP are related to the clinical severity and are the important basis for preoperative evaluation of LPLD. It is helpful to clear the necrotic tissue of the pancreas during the operation and to place the accurate tube around the pancreas. The plane image of common CT is difficult to accurately judge the relationship between the necrotic area of the pancreas, the distribution of peripancreatic effusion and the surrounding blood vessels, and the operation time is prolonged. Risk increase. Ct multiplanar reconstruction is more accurate in evaluating the relationship between pancreatic necrosis areas, peripancreatic effusion distribution and surrounding blood vessels by identifying, reconstructing, and reconstructing stereoscopic images of the pancreas and its surroundings. It has important clinical significance to select the best operative approach, shorten the operation time, reduce the operation injury, improve the clearance rate of pancreatic necrosis focus and ensure the postoperative drainage effect. There are no related research reports at home and abroad. Objective 1. To investigate the clinical effect of laparoscopic catheter drainage in the early stage of severe acute pancreatitis (SAP). 2. To discuss CT multiplanar reconstruction of severe acute pancreatitis to guide laparoscopic catheter drainage surgery. Methods the clinical curative effect of the first stage of severe acute pancreatitis with laparoscopic catheter drainage was analyzed retrospectively. From January 2007 to December 2014, 54 cases of severe acute pancreatitis were treated by laparoscopic catheterization and drainage in our hospital from January 2007 to December 2014. Clinical data of patients with pancreatitis, To observe the clinical effect, to analyze the changes of CT before and after operation, To observe the relationship between CT changes and clinical efficacy. Part two: clinical application of CT multiplanar reconstruction to guide laparoscopic catheter drainage in severe acute pancreatitis. Ct multiplanar reconstruction was performed in 14 patients with SAP from January 2015 to December 2016. The clinical value of laparoscopic catheterization and drainage guided by CT multiplanar reconstruction in 16 SAP patients with conventional CT inspection group from January 2013 to December 2014 was discussed. Results 1. 50 cases were cured and 4 cases died. The mortality rate was 7.4%. 1 case died of pancreatic cancer and 1 case died of multiple organ failure. 2 cases died of delayed abdominal hemorrhage. The mean hospitalization time was 38.7 24. 6 days. Ct showed that pancreatic necrosis remained and peripancreatic infection occurred in 12 cases. 2 patients died of delayed abdominal hemorrhage after reoperation. The CT changes before and after operation were compared. The hospitalization time of the patients with residual pancreatic necrosis and peripancreatic infection was prolonged, and the difference was statistically significant. Compared with the conventional CT scan group, the time of operation was shorter, the amount of bleeding was less, and the days of postoperative hospitalization were less. Conclusion 1. Early laparoscopic catheterization and drainage is safe in the treatment of SAP. Effective treatment. 2. The residual pancreatic necrosis and peripancreatic infection after early laparoscopic drainage were the main causes of prolonged hospitalization and severe complications in patients with SAP. Ct multiplanar reconstruction guidance for severe acute pancreatitis. Laparoscopic catheterization and drainage can improve the safety and effectiveness of the operation.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R576;R816.5

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