马力?李晓锋?熊燃?李海量?曾洁?刘红梅

【摘要】目的 探討中度重症急性胰腺炎早期超声引导下经皮穿刺置管引流术的临床价值。方法 收集89例中度重症急性胰腺炎患者的临床资料，所有患者在入院后均按照《中国急性胰腺炎诊治指南2013》诊治标准进行规范诊治。根据其是否有在早期行超声引导下经皮穿刺置管引流术分为引流组38例和对照组51例，比较2组住院期间病死率、转重症急性胰腺炎率、转外科手术率、住院时间和并发症（感染、胰腺假性囊肿、腹腔内出血、腹腔间室综合征）发生率等。结果 引流组病死率为5%、转重症急性胰腺炎率为18%、转外科手术率为8%，均低于对照组相应的22%、45%、26%（P均< 0.05）。引流组的住院时间短于对照组（P < 0.05）。引流组中胰腺假性囊肿和腹腔间室综合征发生率均低于对照组（P均< 0.05）。2组患者的感染、腹腔内出血发生率比较差异均无统计学意义（P均> 0.05）。结论 早期行超声引导下PCD能有效改善中度重症急性胰腺炎患者预后，缩短其住院时间，减少并发症的发生，且不会增加因穿刺引起的腹腔感染、出血风险。

【关键词】中度重症急性胰腺炎;超声;经皮穿刺引流术;住院时间;并发症

Clinical value of early ultrasound-guided percutaneous catheter drainage for moderately severe acute pancreatitis Ma Li， Li Xiaofeng， Xiong Ran， Li Hailiang， Zeng Jie， Liu Hongmei. The Second School of Clinical Medicine， Southern Medical University， Guangzhou 510280， China

Corresponding author， Liu Hongmei， E-mail： hongmeiliu3@ 163. com

【Abstract】Objective To evaluate the clinical value of early ultrasound-guided percutaneous catheter drainage for moderately severe acute pancreatitis （MSAP）. Methods Clinical data of 89 MSAP patients were retrospectively analyzed. All patients were divided into two groups. In the drainage group （n = 38）， patients received early ultrasound-guided percutaneous catheter drainage. In the control group （n = 51）， no percutaneous drainage was performed. After admission， all patients received standardized diagnosis and treatment according to the "China Guideline for the Diagnosis and Treatment of Acute Pancreatitis in 2013". The mortality rate， the proportion of patients progressing into severe acute pancreatitis （SAP）， the proportion of patients undergoing surgical procedures， length of hospital stay， incidence of complications （infection， pancreatic pseudocyst， intraperitoneal hemorrhage and abdominal compartment syndrome， etc.） were statistically compared between two groups. Results In the drainage group， the mortality rate was 5%， the proportion of patients progressing into SAP was 18% and the proportion of patients undergoing surgical procedures was 8%， significantly lower compared with 22%， 45% and 26% in the control group （all P < 0.05）. The length of hospital stay in the drainage group was significantly shorter than that in the control group （P < 0.05）. In the drainage group， the incidence of pancreatic pseudocyst and abdominal compartment syndrome was remarkably lower compared with that in the control group （both P < 0.05）. The incidence of infection and intraperitoneal hemorrhage did not significantly differ between two groups （both P > 0.05）. Conclusion Early ultrasound-guided percutaneous catheter drainage can effectively improve the clinical prognosis， shorten the length of hospital stay， reduce the incidence of complications， and does not increase the risk of intraperitoneal infection and hemorrhage in MSAP patients.

【Key words】Moderately severe acute pancreatitis （MSAP）;Ultrasound;

Percutaneous catheter drainage;Length of hospital stay;Complication

急性胰腺炎（AP）是临床常见急症，近年来发病率逐年升高，AP病情凶险，如不及时处理，病死率高[1]。AP根据临床表现和预后可分为轻症AP（MAP）、中度重症AP （MSAP）和重症AP （SAP），根据患者就诊时间分为早期（7 d以内）和后期[2]。MSAP具备AP的临床表现以及实验室生物化學指标改变，同时伴有一过性的器官衰竭（48 h内可以自行恢复），或伴有局部的或全身并发症[2]。虽然MSAP患者的病情没有SAP凶险，但临床若处理不慎，则很容易进展为病死率更高的SAP。近年来，AP的外科治疗推崇升阶梯治疗理念，即首先选择创伤较小的超声引导下经皮穿刺引流术（PCD），在PCD无效或病情加重的情况下，才进一步进行腹腔镜探查或剖腹探查等外科治疗[3-4]。……