重症急性胰腺炎的腹腔镜治疗手术时机及手术方式探讨半

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1、维普资讯http://www.cqvip.com第l2卷第3期中国内镜杂志V01．12No．32Oo6年3月ChinaJournalofEndoscopyMar．2O06文章编号：1007—1989(2006)03—0228—03·论著·重症急性胰腺炎的腹腔镜治疗：手术时机及手术方式探讨半蔡小勇，卢榜裕，陆文奇，黄飞，黄玉斌，靳小健，刘祖军，陈永军(广西医科大学微创外科中心，广西南宁530021)摘要：目的探讨腹腔镜治疗重症急性胰腺炎(severeacutepancreatids，SAP)的手术时机、方法及疗效。方法腹腔镜下分离胃结肠韧带，进入网膜腔暴

2、露胰腺，清除渗出液、浓液，通畅脓腔分隔，但不必进行彻底的胰腺坏死组织清创。网膜囊及盆腔置入灌洗管和多根引流管，术后用大量生理盐水持续灌洗引流至引出的灌洗液澄清，并急性肾功能衰竭病人同时盆腔内置入腹膜透析管行腹膜透析。选择腹腔镜手术时间为发病后18h一26d不等。结果治愈17例，1例死于多器官功能衰竭，住院时间28~86d，平均46d。结论采用腹腔镜治疗重症急性胰腺炎对机体的创伤打击小、干扰少，冲洗引流可靠，可有效地改善重症急性胰腺炎的预后，是现行一种安全有效的治疗方法。其手术时机、适应证的选择与传统开腹手术有所不同。关键词：腹腔镜；急性胰腺炎；外科治疗

3、中国分类号：R576文献标识码：ALaparoscopictreatmentofsevereacutepancreatitis：r。lr’。‘ime．i·ndli-cat●ioasanIl1procedlureor一"surgeryCAIXiao—yong，LIJBang—yu，LIJWen-qi，HIJANGFei，HIJANGYIJ-bing，JINXiao-jian，LIIJZu-jun，CHENYong-jun(TheCentreofMinimallyInvasiveSurgery,GuangXiMedicalUniversity,Nannin

4、g,Guaagxi530021，P．R．China)Abstract：【Obstractive】Toevaluatethetime，proceduresandtreatmenteffectsforsevereacutepancreatitis(SAP)underlaparoscopy．【Methods】Thegastrocolicligamentwasopenedunderlaparoseopy．Thepancreaswasthenaccessedandexposedclearly，removingallexudationsandpus，opening

5、Llptheundrainedloeuliplacement．Itasunnecessarytoperformacompletedebridementofallnecrosistissue．D,'ainageandin'igatingcathetetzwereplacedaroundthepancreasandpelviccavity．Largevohlnlesofnormalsalinewereusedtolavageuntiltheabdominalfluidbecameclear．Patientswithacuterenalfailurewere

6、treatedwithperitonealdialysisinthesametime．Thetimefromonsetofthediseasetooperationvariedfrom18hoursto26days．【Results】17patientsrecoveredcompletelyand1patientdieddtlctomulti—systemorganfailm'e．Thelengthofpostoperativehospitalstaywas28to86daysandmeanhospitalstaywas46days．【Conclusi

7、ons】Thelaparoscopictreatnlentinseverepanereatitisappearstobeasafeandeffectiveapproach，withnlinimallyinvasiveandinterfering，eficientindrainageandimprovementinthepatients’prognosis，Thetimeandindicationsofsurgicalinterventionaredifferentfromtheconventionaloperation．KeywoCDDCDDCDDCD

8、Drds：laparoscope；acutepancreatitis；surgicaltrea