本文選題：胰腺炎 + 急性壞死性　； 參考：《中國普通外科雜志》2017年09期

【摘要】：目的:總結(jié)電極片定位超聲引導(dǎo)下經(jīng)皮穿刺置管引流(PCD)治療感染性胰腺壞死(IPN)的經(jīng)驗。方法:回顧性分析2010年10月—2016年12月間61例采用電極片定位超聲引導(dǎo)下PCD治療的IPN的臨床資料。結(jié)果:全組61例均順利施行PCD。23例(37.7%)僅行PCD治療,22例(36.1%)經(jīng)PCD治療后中轉(zhuǎn)微創(chuàng)腹膜后入路胰腺壞死組織清除術(shù)(MARPN),16例(26.2%)患者經(jīng)PCD治療后中轉(zhuǎn)開腹胰腺壞死組織清除術(shù)(OPN)。全組病死率24.6%(15/61),包括僅行PCD治療6例、中轉(zhuǎn)MARPN者4例和中轉(zhuǎn)OPN者5例。PCD術(shù)后并發(fā)癥36例次,包括12例次出血,15例次胰瘺,9例次腸瘺。穿刺引流液培養(yǎng)結(jié)果包括單菌種感染19例(31.1%)和多重感染42例(68.9%),其中多重耐藥菌(MDRO)感染38例(62.3%)。與患者死亡有關(guān)的因素包括2012版急性胰腺炎嚴(yán)重程度分級、外科干預(yù)后膿毒癥是否逆轉(zhuǎn)、穿刺并發(fā)出血以及MDRO感染(均P0.05)。結(jié)論:電極片定位超聲引導(dǎo)下PCD是一種相對簡便安全的胰周穿刺引流方法,以此為基礎(chǔ)的"升階梯"治療策略是治療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.
【作者單位】： 中南大學(xué)湘雅醫(yī)院胰膽外科;中南大學(xué)湘雅醫(yī)院重癥醫(yī)學(xué)科;
【基金】：中南大學(xué)湘雅醫(yī)院管理研究基金資助項目(2016GL12)
【分類號】：R576

【相似文獻】

相關(guān)期刊論文 前1條

1 張亞歷;劉偉;張振書;;急性胰腺炎診治進展[J];現(xiàn)代消化及介入診療雜志;1999年02期

相關(guān)碩士學(xué)位論文 前1條

1 劉鵬;超聲內(nèi)鏡引導(dǎo)下支架置入引流術(shù)對感染性胰腺壞死的療效及安全性分析[D];南昌大學(xué);2016年

，

本文編號：1827741