经皮肾镜治疗重症急性胰腺炎术后残余感染的体会

摘要

Objective To investigate the method and effect of percutaneous nephroscopic necrosectomy(PNN) for post-operatively resident infection of severe acute pancreatitis (SAP).Methods Data of the 15 SAP patients with post-operatively resident infection treated by PNN from June 2008 to December 2014 in Chinese People's Liberation Army General Hospital were reviewed.Twelve of the patients underwent the laparotomy within 1 week,1 in 3rd week,1 in 4th week and the other one on the 127th day.All of the referrals firstly received (multi-)percutaneous catheter drainage (PCD),and then PNN operation according to the disease,followed by continuous irrigation-drainage.Results Eleven patients were healed after received only one PNN operation,2 patients for twice,1 for three times and 1 for four times.The average post-operative time of hospital stay was 66.2 days(10-223 days).The complications after operation contained colon fistula (n ＝ 1),abdominal hemorrhage (n =1),pancreatic pseudocyst (n =1),severe pulmonary infection (n =1).Three patients eventually died.Conclusions Percutaneous nephroscopic necrosectomy is a minimally invasive approach which could prevent the complicated re-laparotomy operation,result in less complication.It is an ideal method for treating SAP patients with post-operatively resident infection.%目的 探讨经皮肾镜微创治疗重症急性胰腺炎(SAP)开腹术后残余感染灶的方法及疗效.方法 回顾性分析自2008年6月至2014年12月解放军总医院采用经皮肾镜微创坏死组织清除术治疗15例SAP开腹治疗术后残余感染患者的资料.男性8例,女性7例,年龄22 ～ 71岁,平均42岁.患者发病至开腹手术时间:1 ～7 d 12例,15 ～21 d 1例,22～28 d 1例,127 d 1例.本组患者均采用先行CT引导下经皮穿刺置管引流,再行经皮肾镜坏死组织清除术,术后持续腹腔内冲洗的治疗方法.结果 15例患者中,11例接受肾镜治疗1次,2例2次,1例3次,1例4次;术后平均住院时间66.2 d(10～223 d);术后1例患者出现结肠瘘予以双套管冲洗治愈;1例出现腹腔内出血行动脉造影未见明显出血,后行剖腹探查止血;1例出现胰腺假性囊肿予以置管引流;1例出现严重的肺部感染.3例患者死亡,死因均为多器官功能衰竭.结论 经皮肾镜胰周坏死织清除术创伤小,避免再次开腹分离粘连、寻找坏死灶所带来的并发症,可能是治疗SAP术后残余感染的理想方法.