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目的探讨经皮肾镜治疗重症急性胰腺炎(SAP)的临床效果。方法对山东省医学科学院附属医院2012年8月至2015年11月期间诊治的86例SAP患者的临床资料进行回顾性分析。根据治疗方式的不同分为肾镜组与开腹组,每组均为43例。2组都给予基础药物治疗,然后开腹组进行常规开腹手术治疗,肾镜组进行经皮肾镜治疗。观察2组患者的术后恢复情况、术后第14 d时的血清C反应蛋白(CRP)含量及术后并发症发生情况。结果 1肾镜组的腹痛缓解时间、肠鸣音恢复时间、体温恢复正常时间和术后住院时间均明显少于开腹组(P<0.05)。2肾镜组与开腹组术后第14 d时的血清CRP含量分别为(8.35±2.13)mg/L和(16.42±2.44)mg/L,均分别明显低于各组术前1 d时的(31.44±3.45)mg/L(P<0.05)和(32.09±2.98)mg/L(P<0.05);且术后第14 d时,血清CRP含量在肾镜组明显低于开腹组(P<0.05)。3肾镜组共发生并发症6例(14.0%),开腹组共发生并发症14例(32.6%),肾镜组的总并发症发生率明显低于开腹组(P<0.05)。结论经皮肾镜治疗SAP具有住院时间短、术后恢复快等优点,能减少术后并发症的发生,其作用机制可能与其缓解全身炎症反应有关。
Objective To investigate the clinical effect of percutaneous nephrolithotomy on severe acute pancreatitis (SAP). Methods The clinical data of 86 SAP patients diagnosed and treated in the Affiliated Hospital of Shandong Academy of Medical Sciences between August 2012 and November 2015 were retrospectively analyzed. According to the different treatment methods are divided into kidney group and open group, each group was 43 cases. 2 groups were given basic drug treatment, and then laparotomy group for conventional laparotomy, and nephroscope group for percutaneous nephrolithotomy. The postoperative recovery of the two groups were observed, the content of serum C-reactive protein (CRP) and the incidence of postoperative complications on the 14th postoperative day. Results 1 Nephrolithromic pain relief time, bowel sounds recovery time, body temperature recovery time and postoperative hospital stay were significantly less than the open group (P <0.05). The levels of CRP in the 14th day after operation in the nephrolithoty group and the open group were (8.35 ± 2.13) mg / L and (16.42 ± 2.44) mg / L, respectively, which were significantly lower than those on the 1st day (31.44 ± 3.45) mg / L (P <0.05) and (32.09 ± 2.98) mg / L respectively (P <0.05). On the 14th day after operation, the level of serum CRP in the nephrolithotomy group was significantly lower than that in the open group (P <0.05). There were 6 complications (14.0%) in the nephrolithiasis group and 14 (32.6%) complications in the open group. The incidence of total complications in the nephrolithotomy group was significantly lower than that in the open group (P <0.05). Conclusion Percutaneous nephroscopy has the advantages of short hospital stay and quick recovery after operation, which can reduce postoperative complications. Its mechanism may be related to the relief of systemic inflammatory response.