目的 探討CT引導(dǎo)下經(jīng)皮穿刺抽液檢查和(或)置管外引流在重癥急性胰腺炎(severe acute pancreatitis,SAP)局部并發(fā)癥中的診治價值。
方法 對我院2003年3月至2008年2月期間收治43例合并胰腺壞死、胰周積液、假性胰腺囊腫及膿腫并發(fā)癥的SAP患者進行了CT引導(dǎo)下經(jīng)皮穿刺抽液檢查和(或)置管外引流,觀察其療效。
結(jié)果 43例SAP患者共穿刺64例次,穿刺成功率為100%。其中24例行診斷性穿刺抽液檢查,診斷符合率為100%。 41例(95%)置管引流48例次,1例直接行開腹手術(shù),1例自動出院。 腹脹緩解率為93%(40/43),中轉(zhuǎn)開腹手術(shù)率為37%(16/43),置管外引流有效率為61%(25/41)。
結(jié)論 采用CT引導(dǎo)下穿刺抽液檢查和(或)置管外引流對部分SAP患者局部并發(fā)癥的診治效果較好。
引用本文: 姚欣敏,于瀾,張抒,肖渝清,楊一村,曹揚,黃江濤,黃德全,羅靜,彭秋生. CT引導(dǎo)下經(jīng)皮穿刺診治重癥急性胰腺炎局部并發(fā)癥的臨床研究(附43例報道). 中國普外基礎(chǔ)與臨床雜志, 2008, 15(8): 560-563. doi: 復(fù)制
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7. | Heath D, Alexander D, Wilson C, et al. Which complications of acute pancreatitis are most lethal? A prospective multicenter study of 719 episodes [J]. Gut, 1995; 36(3)∶A478. |
8. | 李非, 孫家邦. CT引導(dǎo)細(xì)針穿刺診斷胰腺感染的入路選擇[J]. 中國實用外科雜志, 1999; 19(9)∶542. |
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13. | 李維勤, 黎介壽, 趙允召. CT或B超引導(dǎo)下經(jīng)皮穿刺置管引流在重癥急性胰腺炎中的應(yīng)用 [J]. 中國實用外科雜志, 2003; 23(9)∶520. |
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- 1. 張圣道, 雷若慶. 指南后時代重癥急性胰腺炎外科治療的一些關(guān)鍵問題 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007; 14(4)∶381.
- 2. 余文, 吳偉, 張少輝, 等. 急性胰腺炎發(fā)病機理的研究進展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2006; 13(6)∶733.
- 3. Beger HG, Rau B, Isenmann R. Natural history of necrotizing pancreatitis [J]. Pancreatology, 2003; 3(2)∶93.
- 4. Beger HG, Bittner R, Block S, et al. Bacterial contamination of pancreatic necrosis. A prospective clinical study[J]. Gastroenterology, 1986; 91(2)∶433.
- 5. Bradley EL 3rd, Allen K. A prospective longitudinal study of observation versus surgical intervention in the management of necrotizing pancreatitis [J]. Am J Surg, 1991; 161(1)∶19.
- 6. Büchler MW, Gloor B, Müller CA, et al. Acute necrotizing pancreatitis: treatment strategy according to the status of infection [J]. Ann Surg, 2000; 232(5)∶619.
- 7. Heath D, Alexander D, Wilson C, et al. Which complications of acute pancreatitis are most lethal? A prospective multicenter study of 719 episodes [J]. Gut, 1995; 36(3)∶A478.
- 8. 李非, 孫家邦. CT引導(dǎo)細(xì)針穿刺診斷胰腺感染的入路選擇[J]. 中國實用外科雜志, 1999; 19(9)∶542.
- 9. Dervenis C, Johnson CD, Bassi C, et al. Diagnosis, objective assessment of severity, and management of acute pancreatitis. Santorini consensus conference [J]. Int J Pancreatol, 1999; 25(3)∶195.
- 10. King NK, Siriwardena AK. European survey of surgical strategies for the management of severe acute pancreatitis [J]. Am J Gastroenterol, 2004; 99(4)∶719.
- 11. Sandberg AA, Borgstrm A. Early prediction of severity in acute pancreatitis. Is this possible? [J]. JOP, 2002; 3(5)∶116.
- 12. Elmas N. The role of diagnostic radiology in pancreatitis [J]. Eur J Radiol, 2001; 38(2)∶120.
- 13. 李維勤, 黎介壽, 趙允召. CT或B超引導(dǎo)下經(jīng)皮穿刺置管引流在重癥急性胰腺炎中的應(yīng)用 [J]. 中國實用外科雜志, 2003; 23(9)∶520.
- 14. Gouzi JL, Bloom E, Julio C, et al. Percutaneous drainage of infected pancreatic necrosis: an alternative to surgery[J]. Chirurgie, 1999; 124(1)∶31.
- 15. Chen YF, Chiang HJ, Chang JH. Abdominal fluid collection secondary to acute pancreatitis: treated with percutaneous catheter drainage [J]. Zhonghua Yi Xue Za Zhi(Taipei), 1997; 60(5)∶265.
- 16. Neme瘙塂 R, Georgescu I, Mrgritescu D, et al. The pancreatic pseudocyst—late complication of the severe acute pancreatitis. Therapeutic options [J]. Chirurgia (Bucur), 2006; 101(3)∶259.
- 17. 楊寧, 胡立斌, 潘杰, 等. CT引導(dǎo)下胰腺假性囊腫外引流術(shù)的臨床應(yīng)用[J]. 中華放射學(xué)雜志, 2002; 36(10)∶904.
- 18. 張圣道, 雷若慶. 重癥急性胰腺炎診治指南 [C]. 第十一屆全國胰腺外科學(xué)術(shù)研討會論文匯編, 2006∶27.
- 19. 李德宇. 重癥急性胰腺炎手術(shù)指征及療效分析 [J]. 中國普外基礎(chǔ)與臨床雜志, 2005; 12(5)∶499.
- 20. van Sonnenberg E, Wittich GR, Chon KS, et al. Percutaneous radiologic drainage of pancreatic abscesses [J]. AJR Am J Roentgenol, 1997; 168(4)∶979.