经皮经肝胆管引流联合胆道镜引导下清创术治疗胰腺周围感染。
Percutaneous catheter drainage in combination with choledochoscope-guided debridement in treatment of peripancreatic infection.
机构信息
Center of General Surgery, Chengdu General Hospital of Chengdu Military Area Command, Chengdu 610083, Sichuan Province, China.
出版信息
World J Gastroenterol. 2010 Jan 28;16(4):513-7. doi: 10.3748/wjg.v16.i4.513.
AIM
To introduce and evaluate the new method used in treatment of pancreatic and peripancreatic infections secondary to severe acute pancreatitis (SAP).
METHODS
A total of 42 SAP patients initially underwent ultrasound-guided percutaneous puncture and catheterization. An 8-Fr drainage catheter was used to drain the infected peripancreatic necrotic foci for 3-5 d. The sinus tract of the drainage catheter was expanded gradually with a skin expander, and the 8-Fr drainage catheter was replaced with a 22-Fr drainage tube after 7-10 d. Choledochoscope-guided debridement was performed repeatedly until the infected peripancreatic tissue was effectively removed through the drainage sinus tract.
RESULTS
Among the 42 patients, the infected peripancreatic tissue or abscess was completely removed from 38 patients and elective cyst-jejunum anastomosis was performed in 4 patients due to formation of pancreatic pseudocysts. No death and complication occurred during the procedure.
CONCLUSION
Percutaneous catheter drainage in combination with choledochoscope-guided debridement is a simple, safe and reliable treatment procedure for peripancreatic infections secondary to SAP.
目的
介绍并评估一种用于治疗重症急性胰腺炎（SAP）继发胰腺及胰周感染的新方法。
方法
42 例 SAP 患者首先进行超声引导下经皮穿刺置管引流。使用 8Fr 引流导管引流感染性胰周坏死灶 3-5 天。用皮肤扩张器逐渐扩大引流导管窦道，7-10 天后将 8Fr 引流导管更换为 22Fr 引流管。通过引流窦道，在胆道镜引导下反复进行清创，直到有效清除感染性胰周组织。
结果
42 例患者中，38 例患者的胰周感染组织或脓肿被完全清除，4 例患者因形成胰腺假性囊肿而进行了择期胆肠吻合术。在操作过程中，无死亡和并发症发生。
结论
经皮置管引流联合胆道镜引导下清创术是治疗 SAP 继发胰周感染的一种简单、安全、可靠的方法。
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