【摘要】 目的:探讨超声内镜(EUS)引导下穿刺引流术治疗感染性胰腺坏死(IPN)的临床疗效及安全性。方法:回顾性分析2013年1月—2018年12月中南大学湘雅三医院收治的60例行EUS引导下穿刺引流治疗的IPN患者临床资料,比较患者治疗前后生命体征、腹腔内压(IAP)、相关临床评分、实验室检查结果,并分析术后并发症及随访资料。结果:所有患者经EUS引导下穿刺引流术后,其生命体征、IAP、临床评分、实验室检查等指标较术前均得到明显改善(均P<0.05);治疗结果为:治愈10例(16.7%)、明显好转46例(76.6%)、无效4例(6.7%),总有效率达到93.3%;术后严重并发症发生率16.7%,其中胰内瘘3例、肠外瘘1例、肠穿孔3例、出血3例,无手术相关的死亡。56例获随访,其中34例(60.7%)复查CT坏死灶基本吸收,临床症状消失、实验室检验指标无明显异常;10例半年内胰腺炎复发;7例胰腺外分泌功能不全;4例死亡。结论:EUS引导下穿刺引流术在治疗IPN方面,具有较好的临床疗效和安全性。更多还原

【Abstract】 Objective: To investigate the clinical efficacy and safety of endoscopic ultrasound(EUS)-guided puncture and drainage in treatment of infectious pancreatic necrosis(IPN). Methods: The clinical data of 60 patients with IPN undergoing EUS-guided puncture and drainage from January 2013 to December 2018 in the Third Xiangya Hospital of Central South University were retrospectively analyzed. The main vital signs, intraabdominal pressure(IAP), relevant clinical scores, laboratory results of the patients before and after treatment were compared, and the postoperative complications and followed-up of the patients were also analyzed. Results: In all patients after EUS-guided puncture and drainage, the vital signs, IAP, clinical scores and laboratoryfindings were significantly improved compared with those before treatment(all P<0.05). The treatment results were assessed as cure in 10 cases(16.7%), significantly improved in 46 cases(76.6%) and failed in 4 cases(6.7%). The overall effective rate was 93.3%. The incidence of serious complications was 16.7%, including pancreatic fistula in 3 cases, extraintestinal fistula in one case, intestinal perforation in 3 cases and hemorrhage in 3 cases. No procedure-related death occurred in any of them. Follow-up was obtained in 56 patients, and among them, the necrotic lesions were almost completely absorbed in CT scan, the clinical symptoms disappeared and the laboratory indexes showed no obvious abnormal results in 34 cases(60.7%), pancreatitis recurrence occurred within half a year in 10 cases, exocrine pancreatic insufficiency developed in 7 cases, and 4 cases died. Conclusion: EUS-guided puncture and drainage has excellent clinical efficacy and safety in treatment of IPN.更多还原