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目的:探讨重症急性胰腺炎(SAP)合并胰腺周围大量积液不同处理方式的疗效。方法:回顾性分析2008年10月—2016年5月收治的162例SAP合并胰腺周围大量积液患者的临床资料,其中68例行保守治疗(保守治疗组),67例行超声或CT引导下经皮穿刺置管引流治疗(穿刺引流组),13例行腹腔镜手术治疗(腹腔镜组),14例行开腹手术治疗(开腹组),比较各组的相关临床指标。结果:各组一般资料具有可比性;穿刺引流组与腹腔镜组症状体征消失时间、血淀粉酶恢复正常时间均明显短于保守治疗组,保守治疗组腹腔内积液大体吸收时间、膀胱压下降时间明显晚于其余各组(均P<0.05);穿刺引流组与腹腔镜组住院时间明显短于保守治疗组与开腹组,并发症发生率也明显低于保守治疗组与开腹组(均P<0.05);保守治疗组的治疗有效率明显低于其余各组,再手术率明显高于其余各组(均P<0.05);保守治疗组与开腹组病死率明显高于穿刺引流组与腹腔镜组(均P<0.05)。结论:B超或CT引导下穿刺及腹腔镜后入路置管引流对治疗SAP合并胰腺周围大量积液疗效较好,且并发症发生率与病死率较低。
Objective: To investigate the curative effect of different treatment methods for severe acute pancreatitis (SAP) complicated with massive effusion around the pancreas. Methods: The clinical data of 162 SAP patients with massive effusion around the pancreas admitted to our hospital from October 2008 to May 2016 were retrospectively analyzed. Among them, conservative treatment was given in 68 cases (conservative treatment group) and 67 cases were guided by ultrasound or CT Percutaneous catheter drainage (puncture drainage group), 13 cases of laparoscopic surgery (laparoscopic group), 14 cases of laparotomy (laparotomy group), the relative clinical indicators of each group were compared. Results: The general information of each group was comparable. The disappearance time of symptoms and signs and the recovery time of serum amylase were significantly shorter in the puncture drainage group and the laparoscopic group than in the conservative treatment group. The general absorption time of the intraperitoneal effusion in the conservative treatment group and the decrease of the bladder pressure The time was significantly later than the other groups (all P <0.05); the length of stay in laparoscopic group and laparoscopic group was significantly shorter than that in conservative group and laparotomy group, and the complication rate was also significantly lower than that in conservative group and laparotomy group (All P <0.05). The conservative treatment group was significantly lower than the other groups, the reoperation rate was significantly higher than the other groups (all P <0.05); the conservative treatment group and open group mortality was significantly higher than the puncture drainage Group and laparoscopic group (all P <0.05). CONCLUSION: B-ultrasound or CT-guided puncture and laparoscopic retrograde catheterization are effective in treating SAP complicated with massive effusion around the pancreas with low complication rate and mortality.