早期内镜治疗重症急性胰腺炎并发腹腔内高压/腹腔间隔室综合征的效果研究

Clinical study of early endoscopic therapy for severe acute pancreatitis complicated with intra-abdominal hypertension/abdominal compartment syndrome

摘要:

摘要：目的  探讨软式内镜下腹腔灌洗透析对重症急性胰腺炎（SAP）急性反应期并发腹腔内高压（IAH）/腹腔间隔室综合征（ACS）的治疗作用。方法 32例急性反应期并发IAH/ACS的SAP患者在内科常规治疗的基础上给予软式内镜下腹腔灌洗透析治疗，动态监测腹内压（IAP）、急性生理与慢性健康评分（APACHE-Ⅱ）、腹膜刺激征评分的变化及肠鸣音恢复情况；比较治疗前后血清、腹水中肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）水平及腹水淀粉酶含量的变化；统计住院时间及预后。结果 该组患者治愈30例（93.75%），转科2例（6.25%），平均住院（16.53±5.30）d。治疗后1周内随治疗时间延长，患者肠鸣音逐渐恢复，IAP、APACHE-Ⅱ评分及腹膜刺激征评分明显降低（P <0.05），血清TNF-α、IL-6水平及腹水中TNF-α、IL-6、淀粉酶水平明显下降（P <0.05）。结论 软式内镜下腹腔灌洗透析是治疗SAP急性反应期并发IAH/ACS的有效方法，尽早治疗疗效好，具有微创、并发症少的优点。

Abstract:

Abstract: Objective To investigate the effects of peritoneal lavage and dialysis by flexible endoscope in patients with early phase severe acute pancreatitis (SAP) complicated with intra-abdominal hypertension (IAH)/ abdominal compartment syndrome (ACS). Methods 32 patients with early phase SAP complicated with IAH/ACS were received peritoneal lavage and dialysis by flexible endoscope in base of routine treatment. The release time of peritoneal irritation sign, the duration of intra-abdominal hypertension (IAP), bowel sound, APACHE-II scores and prognosis of the patients were evaluated. The levels of TNF-α and IL-6 in serum, also, the concentrations of TNF-α, IL-6 and amylase in ascites/peritoneal lavage fluid were measured. Results 30 patients were all cured after treatment, with an average hospital stay of (16.53 ± 5.30) d, and, 2 patients underwent surgical treatment. The difference between before and after treatment was significance in peritoneal irritation sign scores, bowel sound, IAP and APACHE-II scores of the patients (P < 0.05). The levels of testing items in serum and ascites/peritoneal lavage fluid were decreased significantly during peritoneal lavage and dialysis. Conclusion Continuous peritoneal lavage and dialysis by flexible endoscope is a safe and effective method for patients with SAP complicated with IAH/ACS, especially in the early stage of disease.