"One-step" debridement with retroperitoneal hard-pipe endoscope for peripancreatic infection: 4 cases report and literature review
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摘要:
目的探查CT引导下行腹膜后硬镜“一步法”清创治疗重症急性胰腺炎胰周感染的手术方式。 方法回顾性分析于2017年1月~2019年8月在广东省中医院腹部外科接受CT引导下行腹膜后硬镜“一步法”清创治疗的4例重症急性胰腺炎合并胰周感染患者的临床资料。患者中男性3例，女性1例，年龄47.5±10.4岁。同时对国内外相关文献进行复习。 结果3例患者行1次手术，另外1例因坏死范围扩张，术后第8天行经原引流管窦道行硬镜清创术，术后症状缓解。所有患者术后住院时间为19.75± 7.2 d，术后均无出血、消化道瘘等并发症，随访至今均无假性囊肿等并发症。 结论CT引导下行腹膜后硬镜“一步法”清创治疗重症急性胰腺炎胰周感染能及时治疗控制炎症发展进而缩短住院时间，节省住院费用，是安全、可行的，但有待更多的临床实践及高质量研究提供证据支持。 Abstract:ObjectiveTo explore the operation method of "one-step" debridement under CT guided retroperitoneal hardpipe endoscope in the treatment of severe acute pancreatitis with peripancreatic infection. MethodsWe retrospectively analyzed the clinical data of 4 patients with severe acute pancreatitis complicated with peripancreatic infection who underwent CT-guided retroperitoneal hard-pipe endoscope "one-step" debridement from January 2017 to August 2019 in our Hospital. Three patients were male and one was female. The age was 47.5±10.4 years. The relevant literatures at home and abroad were reviewed. ResultsOne operation was performed in 3 cases, the other one was due to the expansion of necrotic area. On the 8th day after operation, hard mirror debridement through the original drainage tube sinus was performed, and the postoperative symptoms were relieved. The hospital stay after operation was 19.75 ± 7.2 d. Four patients had no complications such as bleeding and gastrointestinal fistula after operation. There were no complications such as pseudocysts in the follow-up. ConclusionCT-guided retroperitoneal hard-pipe endoscope "one-step" debridement is safe and feasible for the treatment of severe acute pancreatitis peripancreatic infection.It can control the development of inflammation in time, shorten the hospitalization time and save the hospitalization cost, but more clinical practice and high-quality research are needed to provide evidence to support it. -
图 1 治疗前CT显示胰腺周围渗出伴坏死组织
Figure 1. CT before treatment showed peripancreatic exudation with necrosis
图 3 术中留取脓液送细菌培养指导术后抗菌用药
Figure 3. During the operation, the pus was collected and sent to the bacterial culture to guide the postoperative antibacterial drugs
表 1 4例患者相关临床资料
Table 1. The related clinical data of 4 patients
编号 年龄(岁) 性别 病因 术前最高体温（℃） MCTSI 手术次数(次） 术后住院时间（d） 1 38 女 胆源性 39.0 6 1 14 2 42 男 高脂性 38.5 8 2 32 3 45 男 酒精性 39.3 4 1 15 4 65 男 高脂性 38.7 4 1 18 MCTSI: Modified CT severity index. 
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