围胰腺区域分步微创治疗重症急性胰腺炎的疗效及预后分析

熊勇; 王何斌; 刘德钦; 陈建勋; 刘建平; 孙昌勤

doi:10.3969/j.issn.1001-5256.2016.03.029

围胰腺区域分步微创治疗重症急性胰腺炎的疗效及预后分析

DOI: 10.3969/j.issn.1001-5256.2016.03.029

攀枝花市中心医院肝胆外科

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中图分类号: R657.51
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出版历程
- 出版日期: 2016-03-20

Effect and prognosis of peri- pancreatic stepwise minimally invasive treatment in patients with severe acute pancreatitis

Department of Hepatobiliary Surgery, Panzhihua Central Hospital

摘要

摘要: 目的探讨重症急性胰腺炎（SAP）患者予以围胰腺区域分步微创治疗的临床疗效及预后。方法回顾性分析2013年1月-2014年12月攀枝花市中心医院诊治的SAP患者110例,按治疗方案的不同分为对照组和治疗组,每组各55例,对照组行开腹手术治疗,研究组行围胰腺区域分步微创治疗,比较两组患者术后的近期疗效、急性生理学及慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、实验室指标[血清淀粉酶（AMS）、白细胞（WBC）、C-反应蛋白（CRP）]及肠道功能恢复时间、并发症发生率和病死率。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果研究组的近期显效率、有效率及总有效率均优于对照组,两组间比较差异均有统计学意义（χ2值分别为5.1665、4.9865、5.6357,P值均<0.05）;两组患者术后1周和出院时的AMS、WBC、血氧饱和度（Sp O2）、CRP水平及APACHEⅡ评分组间比较,差异均有统计学意义（术后1周t值分别13.6585、13.4698、12.0566、14.6856、13.8869,出院时t值分别12.8946、14.2683、13.8963、14.8989、...
- 胰腺炎 /
- 外科手术,微创性 /
- 治疗结果
Abstract: Objective To investigate the clinical effect and prognosis of peri- pancreatic stepwise minimally invasive treatment in patients with severe acute pancreatitis( SAP). Methods The clinical data of 110 patients with SAP who were treated in Panzhihua Central Hospital from January 2013 to December 2014 were analyzed retrospectively,and these patients were divided into two groups( 55 patients in each group) according to the treatment regimen. The patients in the control group were treated with laparotomy,and those in the study group received peri- pancreatic stepwise minimally invasive treatment. The postoperative short- term treatment outcome,Acute Physiology and Chronic Health Evaluation Ⅱ( APACHE Ⅱ) score,laboratory markers [serum amylase( AMS),white blood cell( WBC),and C- reactive protein( CRP) ],time to intestinal recovery,incidence of complications,and mortality were compared between the two groups. The t- test was applied for comparison of continuous data between the two groups,and the chi- square test was applied for comparison of categorical data between the two groups. Results Compared with the control group,the study group had significantly higher short- term marked response rate,response rate,and overall response rate( χ2= 5. 1665,4. 9865 and 5. 6357,all P < 0. 05). There were significant differences in AMS,WBC,pulse oxygen saturation( Sp O2),CRP,and APACHE Ⅱ score between the two groups at 1 week after surgery and at discharge( t =13. 6585,13. 4698,12. 0566,14. 6856,and 13. 8869 for 1 week after surgery,t = 12. 8946,14. 2683,13. 8963,14. 8989,and 13. 0986 for discharge,all P < 0. 05); there was a significant difference in WBC count on day 1 after surgery between the two groups( χ2= 12. 6984,P < 0. 05); both groups showed significant improvements in AMS,WBC,Sp O2,CRP,and APACHE Ⅱ score at 1 week after surgery and at discharge compared with the values on day 1 after surgery,and there were significant changes in these values within each group( all P <0. 05); compared with the control group,the study group had a significantly shorter time to intestinal recovery,a significantly lower mortality rate,and a significantly lower incidence of complications( pleural effusion,dyspnea,false- positive cysts,and wound infection)( t = 13. 6985,P = 0. 042,χ2= 8. 3968,5. 6357,4. 0673,4. 0371,and 4. 4071,all P < 0. 05). Conclusion Peri- pancreatic stepwise minimally invasive treatment has a significant effect in the treatment of SAP and can improve the prognosis of patients. Therefore,it holds promise for clinical application.
- pancreatitis /
- surgical procedures,minimally invasuve /
- treatment outcome

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参考文献(17)

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