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目的观察围胰腺区域分步微创治疗重症急性胰腺炎(SAP)的临床疗效。方法 2003年9月至2009年10月南方医科大学珠江医院肝胆一科对收治的36例SAP病人入院后在实施内科药物治疗同时,立即行局麻下腹部小切口于胰腺上下缘置入腹腔双套管,采用5-FU生理盐水持续滚动冲洗;合并化脓性胆管炎者同时行Oddi括约肌切开取石术(EST)或鼻胆管引流(ENBD)。合并胆囊结石者二期行腹腔镜胆囊切除术(LC),合并胆囊结石和胆总管结石者二期行LC加胆总管切开取石或EST。结果经围胰腺区域微创置管冲洗引流1周后,SAP病人腹腔引流液淀粉酶含量、血淀粉酶含量及白细胞等显著下降(t=2.68,P=0.013;t=2.41,P=0.028;t=2.32,P=0.035)。36例病人全程微创治疗成功,好转率100%,治愈率94.44%,病死率为0。结论围胰腺区域分步微创治疗SAP疗效显著,术后并发症发生率低,值得临床推广应用。
Objective To observe the clinical effect of step-by-step minimally invasive treatment of severe acute pancreatitis (SAP) in the peri-pancreatic region. Methods From September 2003 to October 2009, 36 cases of SAP patients admitted to Zhujiang Hospital of Southern Medical University received an internal medicine treatment at the same time. Immediately under local anesthesia, small abdominal incision Cannula, using 5-FU saline continuous rolling irrigation; suppurative cholangitis with simultaneous Oddi sphincterotomy (EST) or nasobiliary drainage (ENBD). Two patients with gallbladder stones underwent laparoscopic cholecystectomy (LC), with gallstone and common bile duct stones in patients with LC plus common bile duct stones or EST. Results After 1 week of minimally invasive catheter drainage in the peri - pancreatic region, the amylase content, amylase content and white blood cells in peritoneal drainage fluid of SAP patients decreased significantly (t = 2.68, P = 0.013; t = 2.41, P = 0.028; t = 2.32, P = 0.035). 36 cases of minimally invasive treatment of patients throughout the success rate of 100% improvement, cure rate 94.44%, case fatality rate of 0. Conclusion Minimally invasive treatment of peri-pancreatic area with SAP has significant curative effect and low postoperative complication rate, which is worthy of clinical application.