李泉.重症急性胰腺炎合并组织坏死感染患者行经皮穿刺置管引流术的临床价值及预后分析[J].转化医学杂志,2018,7(4):234-236
重症急性胰腺炎合并组织坏死感染患者行经皮穿刺置管引流术的临床价值及预后分析
Clinical value and prognostic factors of percutaneous catheter drainage in severe acute pancreatitis with pancreatic necrosis
  
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中文关键词:  重症急性胰腺炎  周围组织坏死感染  经皮穿刺置管引流术  影响因素
英文关键词:Severe acute pancreatitis (SAP)  Peripheral tissue necrosis infection  Percutaneous catheter drainage  Influencing factors
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作者单位
李泉 广西中医药大学附属瑞康医院 
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中文摘要:
      目的 探讨经皮穿刺置管引流治疗重症急性胰腺炎合并胰腺周围组织坏死感染患者的临床效果及安全性。方法 回顾性分析2012年3月至2017年5月共56例广西中医药大学附属瑞康医院普外科收治的重症急性胰腺炎合并胰腺周围组织坏死感染的患者,根据治疗方式分为引流组与开腹组,比较2组患者入院时的急性生理与慢性健康评分Ⅱ、CT扫描判断下的严重程度指数、入院时器官衰竭比例、治疗前、治疗7 d后的外周血白细胞、血淀粉酶、尿淀粉酶、血糖、血钙、胰瘘率、肠瘘率、腹腔出血率、术后残余脓肿率与治愈率。分析造成患者死亡的影响因素。结果 治疗前后2组患者白细胞、血淀粉酶、血钙、血糖、尿淀粉酶值差异无统计学意义(P>0.05)。治疗7 d后2组患者的白细胞、血淀粉酶、血糖、尿淀粉酶较本组治疗前显著降低(P<0.05),但2组之间比较差异无统计学意义(P>0.05)。引流组的治愈率与开腹组比较差异无统计学意义(P>0.05),但术后引流组患者腹腔出血率显著低于开腹组患者(P<0.05)。多因素分析显示器官衰竭、胰瘘、腹腔出血、血钙水平为造成患者死亡的独立危险因素。结论 经皮穿刺置管引流与开腹手术效果相同,且更不易造成并发症,患者器官衰竭、胰瘘、腹腔出血、血钙水平低于1.5 mmol/L是患者死亡的高危因素。
英文摘要:
      Objective To investigate the clinical efficacy and safety of percutaneous catheter drainage in the treatment of severe acute pancreatitis complicated with pancreatic tissue necrosis. Methods From March 2012 to May 2017, 56 patients with severe acute pancreatitis and pancreatic tissue necrosis were treated in Ruikang Hospital. The patients were divided into drainage group and laparotomy group according to treatment methods. Acute physiology and chronic health evaluation Ⅱ, CT scan, organ failure ratio, white blood cell, serum amylase, urine amylase, blood sugar, serum calcium, the rate of pancreatic fistula, intestinal fistula, abdominal bleeding rate, postoperative residual rate abscess rate and cure rate were compared. The influencing factors of death were studied. Results Before and after treatment, there was no significant difference in white blood cell, serum amylase, serum calcium, blood glucose, urine amylase between the two groups (P>0.05). After 7 days of treatment, the above indicators were significantly lower than those before treatment (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no significant difference in the cure rate between the drainage group and the laparotomy group, but the abdominal bleeding rate in the postoperative drainage group was significantly lower than that in the laparotomy group (P<0.05). Multivariate analysis showed that organ failure, pancreatic fistula, abdominal bleeding and serum calcium levels were independent risk factors for death. Conclusion Percutaneous catheter drainage is as well as laparotomy, that is less likely to cause complications. The organ failure, pancreatic fistula, abdominal bleeding, blood calcium level lower than 1.5 mmol/L are risk factors for death.
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