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Assessment of the therapeutic efficacy and safety of natural orifice transluminal endoscopic surgery in patients with fulminant acute pancreatitis
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摘要:
目的探讨经自然腔道内镜手术（NOTES）治疗暴发性急性胰腺炎（FAP）的方法及效果。方法 24例FAP患者入院4 h内实施NOTES治疗,清除腹腔渗液,冲洗腹腔,腹腔置管,术后持续腹腔灌洗及腹膜透析1周。结果术前腹腔内压力（29.2±5.6）cm H2O,NOTES术后第2 d降至（8.60±2.65）cm H2O。肠蠕动NOTES术后第2 d开始恢复,（1.68±1.02）次/min,第6 d肠蠕动恢复正常,（4.30±1.75）次/min。NOTES术后外周血中肿瘤坏死因子（TNF）α、白细胞介素（IL）-6、IL-8值较NOTES术前显著下降（P<0.01）。NOTES术前APACHE II评分（16.2±4.8）分,NOTES术后第6 d（6.46±1.84）分。24例患者均痊愈,平均住院日（23.98±7.88）d。结论经NOTES清除腹腔渗液,降低腹腔压力,透析排出炎症介质,是治疗FAP的一种安全有效的方法。
Abstract:Objective To evaluate the therapeutic effect of natural orifice transluminal endoscopic surgery (NOTES) intervention in a cohort of patients treated for fulminant acute pancreatitis (FAP) over a five-year period.Methods Between September 2007 and June 2012, 24 patients were treated with NOTES within 72 h of FAP onset and included 18 males and six females between the ages of 21-76 years old.The procedure was performed via the mouth to the stomach wall for penetration into the abdominal cavity and extraction of the inflammatory secretion followed by saline washes and lavage tube placement.Abdominal cavity lavage and peritoneal dialysis were carried out for one week.Outcome measures included abdominal pressure, bowel sounds, serum levels of inflammatory markers (tumor necrosis factor-alpha (TNFα) , interleukin (IL) -6, and IL-8) , recovery time, and APACHE II score Data were analyzed using the Chi-squared test or F-test.Results In 19 patients, the peritoneal effusion fluid volume removed during the NOTES procedure ranged from 200-2100 ml, and involved serous (n=7) , blood (n=5) , cellulose (n=5) , and suppurative (n=2) fluids.In four patients, the lesser omental bursa effusion fluid volume ranged from 460-2500 ml, and involved serous (n=2) and blood (n=2) fluid.Abdominal pressure had decreased by day 2 after the NOTES procedure (8.60±2.65 vs.admission: 29.2±5.6 cm H2O) .Intestinal peristalsis (admission: 1.68±1.02 times/minute) was resolved by day 6 after the NOTES procedure (4.30±1.75 times/minute) .Serum levels of TNFα, IL-6, and IL-8 were decreased significantly after the NOTES procedure (admission vs.day 6, all P<0.01) .In addition, APACHE II score decreased after the NOTES procedure (admission: 12.76±6.68 vs.day 6: 6.46±1.84) .The cure rate was 95.8%, and only one patient died (due to progressive multiple organ failure) .The mean duration of hospital stay was 21.98±7.88 days.Conclusion NOTES intervention with extraction of the inflammatory secretion from the abdominal cavity effectively lowered the peritoneal pressure and inflammatory state within one week, and is a safe and efficient method to treat patients with FAP.
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