本文選題：胰性液體積聚 + 經(jīng)皮穿刺置管引流　； 參考：《浙江大學(xué)》2016年博士論文

【摘要】：背景：胰性液體積聚(PFCs)在急性胰腺炎(AP)中很常見,由1992年亞特蘭大會(huì)議(1992-AC)正式定義。2012年亞特蘭大改良標(biāo)準(zhǔn)(2012-RAC)將PFCs分為：急性胰周液體積聚(APFCs),胰腺假性囊腫,急性壞死性積聚(ANC)和包裹性壞死(WON)四種類型。APFCs與ANC出現(xiàn)在AP早期階段,而胰腺假性囊腫與WON則見于AP后期。PFCs對AP的預(yù)后產(chǎn)生不利影響。在AP早期,PFCs會(huì)加重局部及全身組織的炎癥反應(yīng),導(dǎo)致腹腔內(nèi)高壓,引起或加重臟器功能衰竭(OF),使AP病情加重。而在AP后期,持續(xù)、進(jìn)展的PFCs可壓迫周圍器官造成梗阻,以胃流出道梗阻(GOO)最為常見；還可造成假性動(dòng)脈瘤、出血及門靜脈、脾靜脈栓塞等并發(fā)癥。PFCs可無菌存在,亦可合并感染。自Freeny在1998年首次報(bào)道采用經(jīng)皮穿刺置管引流術(shù)(PCD)成功治療感染壞死性胰腺炎(INP)后,此項(xiàng)技術(shù)便逐漸推廣起來。既往基于1992-AC觀點(diǎn),認(rèn)為大部分無菌性PFCs能自行吸收,過早PCD干預(yù)會(huì)增加感染風(fēng)險(xiǎn),因而不主張對PFCs行早期PCD治療,但該觀點(diǎn)缺乏臨床依據(jù)。自2012-RAC對AP的類型、嚴(yán)重程度及PFCs定義改良后,以前大部分重癥急性胰腺炎(SAP)均可納入中重度急性胰腺炎(MSAP),從而使得SAP診斷更加準(zhǔn)確。根據(jù)2012-RAC標(biāo)準(zhǔn),SAP早期PFCs主要為ANC,而大于5cm的ANC很難自行吸收,因此,理論上我們可以對PFCs行PCD干預(yù)治療。既往對于AP后期由PFCs壓迫引起的GOO常行手術(shù)治療,如果先行PCD治療,其療效如何,目前亦缺乏相關(guān)研究。目的：研究伴有無菌性PFCs的AP行早期PCD治療的安全性及療效；評估PCD對于AP后期由PFCs造成的GOO的緩解作用。方法：1、229例1992-AC標(biāo)準(zhǔn)的SAP患者納入研究。按照2012-RAC嚴(yán)重程度標(biāo)準(zhǔn)及受累OF的數(shù)量和時(shí)間分為：SAP(a)+MOF, SAP(a)+SOF, SAP(b)+MOF, SAP(b)+ SOF, MSAP伴OF,MSAP不伴OF等六個(gè)亞組。162例伴有無菌性PFCs,其中105例2周內(nèi)行PCD治療,另外57例行保守治療。比較各組的手術(shù)率、感染率及死亡率。2、自2010年7月-2013年7月,148例AP患者納入研究。25例伴有胃排空障礙,其中12例由胃癱引起,1例由胃內(nèi)真菌絲梗阻造成,12例確診為GOO。其中8例為胰腺假性囊腫引起,4例由WON引起,均給予PCD治療。結(jié)果：1、大量的PFCs在SAP(a)與SAP(b)+MOF組中的發(fā)生率(80%)高于SAP(b)+SOF和MSAP組(60%)。在重癥組中,PCD減少了SAP(a)的手術(shù)率,減少了SAP(a)+SOF和SAP(b)中的感染率和SAP(a)和SAP(b)+MOF組中的死亡率；相反,增加了MSAP組的手術(shù)率和感染率。2、12例GOO通過PCD治療均得到緩解,PP組平均緩解時(shí)間為6天,WON組為37.25天；5例出現(xiàn)了囊腔內(nèi)感染,通過PCD治療后均得到有效控制；3例出現(xiàn)胰瘺,其中2例經(jīng)PCD引流緩解,1例行囊腫空腸造口術(shù)治愈。結(jié)論：1、在AP中,PFCs的量與胰腺炎的嚴(yán)重程度和累及臟器功能衰竭的強(qiáng)度呈正相關(guān)；早期階段的無菌性PFCs行PCD治療可以緩解SAP的進(jìn)展,但對MSAP沒有益處。2、AP后期伴有假性囊腫或WON引起的GOO,行多部位,大口徑的PCD治療是一項(xiàng)安全、有效的微創(chuàng)方法。
[Abstract]:Background: pancreatic fluid accumulation (PFCs) is common in acute pancreatitis (AP), as defined by the 1992 Atlanta Conference (1992-AC). The 2012 Atlanta improved criteria (2012-RAC) classify PFCs into acute peripancreatic fluid accumulation (APFCs), pancreatic pseudocysts, and pancreatic pseudocysts. Four types of acute necrotic accumulation (ANC) and encapsulated necrosis (WON). APFCs and ANC appeared in the early stage of AP, while pancreatic pseudocyst and WON were found in the late stage of AP. PFCs had adverse effects on the prognosis of AP. In the early stage of AP, PFCs may aggravate the inflammatory reaction of local and systemic tissues, lead to intraperitoneal hypertension, cause or aggravate organ failure (of), and aggravate the condition of AP. In the later stage of AP, progressive PFCs can compress the surrounding organs to cause obstruction, especially gastric outflow tract obstruction (GOO), and may cause pseudoaneurysm, hemorrhage, portal vein embolism and other complications. PFCs may be sterile. It can also be combined with infection. Since Freeny first reported the successful treatment of infectious necrotizing pancreatitis (INP) with percutaneous catheter drainage (PCD) in 1998, this technique has been gradually popularized. According to 1992-AC view, most aseptic PFCs can be absorbed by themselves, and early PCD intervention will increase the risk of infection. Therefore, it is not recommended to treat PFCs with early PCD therapy, but this view lacks clinical basis. Since the classification, severity and PFCs definition of AP were improved by 2012-RAC, most severe acute pancreatitis (SAP) were included in MSAP, which made the diagnosis of SAP more accurate. According to the 2012-RAC standard, the early stage of 5cm is mainly ANC, but it is difficult to absorb 5cm by itself. Therefore, we can use PCD intervention therapy in theory. In the past, GOO caused by PFCs compression in the later stage of AP is often treated by surgery. If PCD is used first, what is the curative effect, and there is a lack of relevant research at present. Aim: to study the safety and efficacy of early PCD therapy for AP with aseptic PFCs, and to evaluate the effect of PCD on the remission of goo caused by PFCs in the later stage of AP. Methods one hundred and twenty-nine SAP patients with 1992-AC criteria were included in the study. According to the severity criteria of 2012-RAC and the number and time of involved of, the patients were divided into six subgroups: SAP (a) mof, SAP (a) SOF, SAP (b) MOF, SAP (b) SOF, MSAP with OFN MSAP without of 6 subgroups. Among them, 105 cases received PCD treatment within 2 weeks, and 57 cases received conservative treatment. From July 2010 to July 2013, 148 patients with AP were included in the study. There were 25 patients with gastric emptying disorder, 12 patients with gastric mycelium obstruction caused by gastroparesis and 12 patients diagnosed as goo. Among them, 8 cases were caused by pancreatic pseudocyst, 4 cases were caused by WON, all of them were treated with PCD. Results the incidence of massive (a) in SAP (a) and SAP (b) MOF group (80%) was higher than that in SAP (b) SOF and SAP (b) group (60%). In the severe group, PCD reduced the rate of operation, the infection rate in SAP (a) and (b) and the mortality rate in SAP (a) and SAP (b) MOF groups. The rate of operation and the infection rate in MSAP group were increased. 12 cases of goo were treated with PCD. The average remission time of PP group was 6 days and that of WON group was 37.25 days. There were 5 cases with intracystic infection and 3 cases with pancreatic fistula were effectively controlled after PCD treatment. Among them, 2 cases were relieved by PCD drainage and 1 case was cured by cyst jejunostomy. Conclusion: the amount of PFCs in AP is positively correlated with the severity of pancreatitis and the intensity of organ failure, and the early stage of aseptic PFCs treatment with PCD can alleviate the progression of SAP. However, there is no benefit to MSAP. 2Goo caused by pseudocyst or WON in late stage of MSAP. It is a safe and effective minimally invasive method to treat MSAP with multi-site and large-caliber PCD.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R657.51

【相似文獻(xiàn)】

相關(guān)期刊論文 前4條

1 孫家邦;朱斌;;炎性胰腺液體積聚的內(nèi)鏡治療[J];中國微創(chuàng)外科雜志;2006年10期

2 崔恒斌;;兩側(cè)腹小切口腹膜后引流術(shù)治療重癥急性胰腺炎急性液體積聚[J];哈爾濱醫(yī)藥;2012年06期

3 朱瑋;兩側(cè)腹小切口腹膜后引流術(shù)治療重癥急性胰腺炎急性液體積聚[J];外科理論與實(shí)踐;2001年04期

4 ;[J];;年期

相關(guān)會(huì)議論文 前1條

1 劉納新;朱江;楊建榮;黃卡特;余震;;急性壞死性胰腺炎局部因素致腸道損傷的實(shí)驗(yàn)研究[A];2013年浙江省腸外腸內(nèi)營養(yǎng)學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2013年

相關(guān)博士學(xué)位論文 前1條

1 張紹陽;經(jīng)皮穿刺引流術(shù)對急性胰腺炎不同時(shí)期的無菌性胰性液體積聚治療作用的研究[D];浙江大學(xué);2016年

，

本文編號(hào)：2100536