Rubtsov M A, Galeev S I
Saint-Lucas Clinical Hospital, Saint Petersburg, Russian Federation.
Case Rep Gastroenterol. 2009 Apr 17;3(1):97-104. doi: 10.1159/000212991.
Unsatisfactory results of surgery in the late course of pancreatic necrosis made us search for indications and variants of operation in the early phase of the disease. As early surgical intervention, the universal approach was used in 7 patients with necrotizing pancreatitis who had a different prevalence of the inflammatory process in the retroperitoneal space. The drainage proved to be effective and enabled us to always prevent generalized infectious complications in the later phases of the disease in absence of local complications specific for open surgery: bleeding and digestive fistulas. In spite of obvious infected process development in primary open surgery, we noticed a stable decrease in procalcitonin level following the drainage. A surgical intervention has been developed enabling one to reveal in time the volume of damaged retroperitoneal fat tissue and to drain it adequately in compliance with the process prevalence, thus avoiding septic complications in the late phase of the disease. The method's advantage involves refusal from necrosectomy in primary intervention, weekly staged revisions of the retroperitoneal space via formed contrapertures as dictated by evolution of the necrotic process in the gland.
胰腺坏死晚期手术效果不理想，促使我们探寻该病早期阶段的手术指征及术式变体。作为早期手术干预措施，我们对7例坏死性胰腺炎患者采用了通用方法，这些患者腹膜后间隙炎症进程的发生率各异。引流被证明是有效的，且在没有开放性手术特有的局部并发症（出血和消化瘘）的情况下，使我们始终能够预防疾病后期的全身性感染并发症。尽管在初次开放性手术中明显出现了感染进程，但我们注意到引流后降钙素原水平持续下降。我们开发了一种手术干预方法，能够及时发现受损腹膜后脂肪组织的体积，并根据炎症进程的发生率对其进行充分引流，从而避免疾病后期的感染并发症。该方法的优点包括在初次干预时不进行坏死组织切除术，根据胰腺坏死进程的演变，每周通过形成的对孔对腹膜后间隙进行分期复查。
