目的 探索外科干预联合超声内镜下穿刺引流治疗感染性胰腺坏死(infected pancreatic necrosis,IPN)的临床疗效.方法 本研究采用回顾性、历史对照研究设计,收集2016年6月至2023年1月期间成都市第三人民医院收治的98例符合纳入和排除标准的急性胰腺炎(acute pancreatitis,AP)合并IPN患者作为研究对象.根据超声内镜下穿刺引流开展时间点(2020年6月),将2020年5月及之前的患者分入非EUS组(52例),将2020年6月及之后的患者分入EUS组(46例).分析比较2组患者的基线资料、外科干预、总住院时间、重症医学科(intensive care unit,ICU)住院时间、感染时间、多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)、生存情况、近远期并发症等指标.结果 EUS组的经皮穿刺置管引流(percutaneous catheter drainage,PCD)次数(1.0次vs.1.0次)、PCD引流管留置数量(1.0根vs.2.0根)、经腹膜后清创引流次数(1.0次vs.2.0 次)、总住院时间(42.0 d vs.45.5 d)、ICU 时间(11.0 d vs.14.0 d)、感染时间(10.5 d vs.18.5 d)、MODS 发生率[43.5％(20/46)vs.67.3％(35/52)]及残余感染发生率[28.3％(13/46)vs.48.1％(25/52)]均短于(低于)非 EUS 组(P＜0.05);但2组患者的经内镜胰管支架置入次数、开腹手术次数、经腹腔入路腹腔镜手术次数,以及腹腔出血、消化道瘘、消化道梗阻、慢性胰瘘、慢性胰腺炎和切口疝发生率比较差异均无统计学意义(P＞0.05).结论 对于合并IPN的AP患者,外科干预联合超声内镜下穿刺引流治疗可减少PCD次数和引流管数目,同时缩短总住院时间、ICU时间和感染时间,减少MODS和残余感染的发生.
Evaluation of the clinical effect of surgical intervention combined with endoscopic ultrasound-guided transluminal drainage in the treatment of infectious pancreatic necrosis:a retrospective,historical control study
Objective To evaluate the clinical efficacy of surgical intervention combined with endoscopic ultrasound-guided transluminal drainage in the treatment of infected pancreatic necrosis(IPN).Methods A retrospective,historical control study was conducted.A total of 98 patients with acute pancreatitis(AP)complicated with IPN who met the inclusion and exclusion criteria and were admitted to the Third People's Hospital of Chengdu from June 2016 to January 2023 were selected as the research objects.The endoscopic ultrasound-guided transluminal drainage was carried out in our hospital in June 2020.In this study,patients treated before May 2020 were divided into the non-EUS group(52 cases),and patients treated after June 2020 were divided into the EUS group(46 cases).The baseline data,surgical intervention,length of hospital stay,length of intensive care unit(ICU)stay,infection time,incidence of multiple organ dysfunction syndrome(MODS),survival situation,short-term and long-term complications,and other indicators were compared between the two groups.Results The number of percutaneous catheter drainage(PCD,1.0 vs.1.0),the number of PCD drainage tube(1.0 vs.2.0),the number of retroperitoneal debridement drainage(1.0 vs.2.0),the total length of hospital stay(42.0 d vs.45.5 d),the length of ICU stay(11.0 d vs.14.0 d),the length of infection time(10.5 d vs.18.5 d),the incidences of MODS[43.5％(20/46)vs.67.3％(35/52)]and residual infection[28.3％(13/46)vs.48.1％(25/52)]in the EUS group were shorter(or lower)than those in the non-EUS group(P＜0.05);but there were no significant differences in the number of endoscopic pancreatic stent implantation,the number of laparotomy,the number of laparoscopic surgery,and the incidences of abdominal bleeding,gastrointestinal fistula,gastrointestinal obstruction,chronic pancreatic fistula,chronic pancreatitis and incisional hernia between the two groups(P＞0.05).Conclusion For patients with AP complicated with IPN,surgical intervention combined with endoscopic ultrasound-guided transluminal drainage can reduce the number of PCD and drainage tube,shorten the total length of hospital stay,the length of ICU stay and infection,as well as reduce the incidences of MODS and residual infection.
万方数据
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