Van Vyve E L, Reynaert M S, Lengele B G, Pringot J T, Otte J B, Kestens P J
Department of Surgery, St-Luc University Hospital, Louvain-en-Woluwe Medical School, Bruxelles, Belgium.
Surgery. 1992 Apr;111(4):369-75.
From 1982 to 1988, 20 patients with pancreatic abscesses after an acute necrotizing pancreatitis underwent a retroperitoneal laparostomy (RPL).
The severity of the disease was assessed by Ranson's bioclinical and Hill's computed tomographic scoring systems. The RPL, guided by the results of repeated computed tomographic scans (high frequency of peripancreatic necrotic extension through the anterior pararenal space) consists of a left or right lateral incision under the twelfth rib, allowing direct access to the pancreas and peripancreatic spaces.
Four patients (20%) had local complications: colonic fistula (one patient), gastric and colonic fistula (one patient), jejunal fistula (one patient), and local hemorrhage (one patient). Only one complication was lethal (gastric and colonic fistula). Four patients died (mortality rate 20%). In two of the cases death was related directly to a persistent sepsis after the RPL, whereas the two other patients died despite a complete surgical drainage.
RPL (left or right, sometimes bilateral) allows a total exploration of the pancreas and peripancreatic spaces in most cases, as well as a complete manual removal of the necrotic infected masses. Furthermore, several second-look removals of newly formed necrotic masses can be performed without the risk of peritoneal contamination and with a low rate of digestive fistula.
1982年至1988年，20例急性坏死性胰腺炎后发生胰腺脓肿的患者接受了腹膜后剖腹术（RPL）。
通过兰森生物临床评分系统和希尔计算机断层扫描评分系统评估疾病的严重程度。RPL在重复计算机断层扫描结果的指导下（胰腺周围坏死通过肾旁前间隙广泛蔓延的频率较高），通过在第十二肋下做左或右侧切口，直接进入胰腺和胰腺周围间隙。
4例患者（20%）出现局部并发症：结肠瘘（1例）、胃结肠瘘（1例）、空肠瘘（1例）和局部出血（1例）。仅1例并发症致死（胃结肠瘘）。4例患者死亡（死亡率20%）。其中2例患者的死亡与RPL术后持续败血症直接相关，而另外2例患者尽管手术引流彻底仍死亡。
RPL（左或右，有时双侧）在大多数情况下可全面探查胰腺和胰腺周围间隙，并能完整地手动清除坏死感染灶。此外，可多次对新形成的坏死灶进行二次清除，而无腹腔污染风险且消化瘘发生率低。
