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目的:评价超声引导下经皮穿刺置管引流(PCD)治疗重症急性胰腺炎(SAP)的安全性及临床疗效。方法:回顾性分析2011年1月-2015年12月在超声引导下经皮穿刺置管引流的273例SAP患者的临床资料,比较患者引流前后外周血白细胞(WBC)、血清白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平的变化。结果:273例患者中,131例患者仅经过PCD术后治愈出院;103例患者行超声引导下PCD术后全身症状得到明显改善,后期再采用经腹膜后内镜下清创术治愈出院,39例患者无好转,中转为开腹手术,PCD术的成功率为100%。103例经内镜下清创的患者中2例死亡,39例无好转的开腹手术患者中13例死亡。患者引流后外周血白细胞(WBC)、血清白介素-6(IL-6)、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平均较引流前显著降低,差异有统计学意义(P<0.05)。结论:采用超声引导下的经皮穿刺置管引流治疗SAP具有定位准确、创伤小的有点,可使部分患者免于手术,或者为后续治疗创造有利条件,临床疗效显著。
Objective: To evaluate the safety and clinical efficacy of ultrasound guided percutaneous catheter drainage (PCD) in the treatment of severe acute pancreatitis (SAP). Methods: The clinical data of 273 SAP patients undergoing percutaneous catheterization under ultrasound guidance from January 2011 to December 2015 were retrospectively analyzed. The changes of peripheral blood leukocytes (WBC), serum interleukin-6 -6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) levels. Results: Among the 273 patients, 131 patients were cured only after PCD. 103 patients underwent ultrasound-guided PCD. The symptoms of the whole body were significantly improved. The patients were treated by retroperitoneal endoscopic debridement and were discharged at the later stage. 39 Cases of patients without improvement, the switch to open surgery, PCD surgery was 100% success rate. Two of the 103 patients who underwent endoscopic debridement died, and 13 of 39 patients who did not benefit from laparotomy died. The levels of peripheral blood leucocytes (WBC), serum interleukin-6 (IL-6), C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) in patients after drainage were significantly lower than those before drainage, the difference was statistically significant (P <0.05). Conclusion: Percutaneous puncture and catheter drainage under the guidance of ultrasound can be used to treat SAP with accurate positioning and small trauma, which can make part of patients free from surgery or create favorable conditions for subsequent treatment. The clinical curative effect is remarkable.