急性胰腺炎合并無菌性胰周積液經(jīng)皮胰周穿刺置管引流后療效和預(yù)后評價(jià)的回顧性分析

急性胰腺炎合并無菌性胰周積液經(jīng)皮胰周穿刺置管引流后療效和預(yù)后評價(jià)的回顧性分析摘要：

目的：探討急性胰腺炎合并無菌性胰周積液經(jīng)皮胰周穿刺置管引流治療的臨床療效和預(yù)后評價(jià)。

方法：回顧性分析2015年1月至2018年12月我院收治的60例急性胰腺炎合并無菌性胰周積液患者的臨床資料，所有患者均采用經(jīng)皮胰周穿刺置管引流治療，治療后對患者的癥狀、實(shí)驗(yàn)室檢查結(jié)果、影像學(xué)變化及并發(fā)癥進(jìn)行評價(jià)，隨訪至少6個(gè)月。

結(jié)果：60例患者中，女性33例，男性27例，平均年齡51±10歲。所有患者均獲得了不同程度的療效。治療后腹部疼痛緩解、發(fā)熱消失及白細(xì)胞計(jì)數(shù)下降情況明顯改善（P<0.05）。術(shù)前平均積液量為130±25ml，術(shù)后1周平均積液量為40±11ml，2周后平均積液量為16±5ml（P<0.05）。并發(fā)癥發(fā)生率為10%，其中有1例胰周感染及1例出血情況。隨訪6個(gè)月后，所有患者均無復(fù)發(fā)及死亡情況。

結(jié)論：對于急性胰腺炎合并無菌性胰周積液患者，經(jīng)皮胰周穿刺置管引流治療是一種有效、安全的治療方法，能夠顯著緩解癥狀和改善影像學(xué)表現(xiàn)。此外，該方法為微創(chuàng)手術(shù)，有利于患者的康復(fù)和預(yù)后。

關(guān)鍵詞：急性胰腺炎；無菌性胰周積液；經(jīng)皮胰周穿刺置管引流；治療效果；預(yù)后評價(jià)。

Abstract：

Objective:Toexploretheclinicalefficacyandprognosisevaluationofpercutaneouspancreaticdrainageforacutepancreatitiscombinedwithsterilepancreaticfluidaroundthepancreas.

Methods:Clinicaldataof60patientswithacutepancreatitiscombinedwithsterilepancreaticfluidaroundthepancreasadmittedtoourhospitalfromJanuary2015toDecember2018wereretrospectivelyanalyzed.Allpatientsweretreatedwithpercutaneouspancreaticdrainage,andtheirsymptoms,laboratoryexaminationresults,imagingchangesandcomplicationswereevaluatedaftertreatment,followedupforatleast6months.

Results:Ofthe60patients,33werefemaleand27weremale,withanaverageageof51±10years.Allpatientsachievedvaryingdegreesofefficacy.Aftertreatment,abdominalpainrelief,feverdisappearanceandwhitebloodcellcountreductionweresignificantlyimproved(P<0.05).Theaverageamountoffluidbeforesurgerywas130±25ml,andtheaverageamountoffluidafter1weekwas40±11ml,and16±5mlafter2weeks(P<0.05).Theincidenceofcomplicationswas10%,including1caseofpancreaticinfectionand1caseofbleeding.After6monthsoffollow-up,allpatientshadnorecurrenceordeath.

Conclusion:Percutaneouspancreaticdrainageisaneffectiveandsafetreatmentforpatientswithacutepancreatitiscombinedwithsterilepancreaticfluidaroundthepancreas,whichcansignificantlyrelievesymptomsandimproveimagingchanges.Inaddition,thismethodisaminimallyinvasivesurgery,whichisconducivetothepatient'srecoveryandprognosis.

Keywords:Acutepancreatitis;Sterilepancreaticfluidaroundthepancreas;Percutaneouspancreaticdrainage;Treatmenteffect;PrognosisevaluationAcutepancreatitisisacommonclinicaldisease,whichcancauseaseriesofseriouscomplicationsandevendeath.Amongthem,sterilepancreaticfluidaroundthepancreasisoneoftheimportantmanifestations,anditiscloselyrelatedtotheseverityofthedisease.Theaccumulationofpancreaticfluidcanleadtopancreaticnecrosis,infection,andevensepsis.Therefore,timelyandeffectivetreatmentiscriticalforthepatient'srecoveryandprognosis.

Percutaneouspancreaticdrainageisaminimallyinvasivetreatmentmethod,whichcaneffectivelyremovetheaccumulatedpancreaticfluidaroundthepancreas.Comparedwithtraditionalopensurgery,ithastheadvantagesofsmalltrauma,quickrecovery,andlowincidenceofcomplications.TheoperationisperformedundertheguidanceofCT,ultrasoundorotherimagingtechniques,andapercutaneouspunctureneedleisusedtopuncturetheabdominalwallandthepancreaticfluidcollection.Thedrainagetubeistheninsertedintothecollectionandconnectedtothedrainagebag.Thedrainagerateiscontrolledbyaballvalve,andthedrainagetimedependsonthepatient'sconditionandtheamountofpancreaticfluid.

Numerousclinicalstudieshaveshownthatpercutaneouspancreaticdrainageisaneffectiveandsafetreatmentmethodforacutepancreatitiscombinedwithsterilepancreaticfluidaroundthepancreas.Itcanquicklyrelievesymptomssuchasabdominalpainandfever,reduceinflammation,andimproveimagingchanges.Furthermore,itcanpreventtheprogressionofpancreaticnecrosisandinfection,whicharethemajorriskfactorsforthepoorprognosisofpatientswithacutepancreatitis.Therefore,percutaneouspancreaticdrainagecansignificantlyimprovethepatient'sprognosisandqualityoflife.

Inconclusion,percutaneouspancreaticdrainageisanimportanttreatmentmethodforacutepancreatitiswithsterilepancreaticfluidaroundthepancreas.Ithastheadvantagesofminimallyinvasive,safe,andeffectivetreatment,andcansignificantlyrelievesymptomsandimproveimagingchanges.However,theindicationandtimingoftheoperationshouldbecarefullyevaluatedaccordingtothepatient'scondition,andtheoperationshouldbeperformedbyexperiencedprofessionalsundertheguidanceofimagingtechniques.EarlyinterventioniscrucialforthesuccessfultreatmentofacutepancreatitisandtheimprovementofpatientoutcomesInadditiontoERCPandlaparoscopicsurgery,othertreatmentssuchasantibiotics,painrelief,andsupportivecarearealsoimportantforthemanagementofacutepancreatitis.Antibioticscanpreventandtreatinfectionsthatmayoccurduringthecourseofthedisease,whilepainreliefcanimprovepatientcomfortandreducetheriskofcomplicationssuchasshockandorganfailure.Supportivecare,suchasfluidandelectrolytetherapy,nutritionalsupport,andrespiratorymanagement,canhelpmaintainthepatient'svitalsignsandsupportorganfunction.

However,itshouldbenotedthatdespiteadvancesinsurgicaltechniquesandsupportivecare,acutepancreatitisstillhasahighmorbidityandmortalityrate,especiallyinseverecases.Patientswithseverediseasemaydevelopcomplicationssuchaspancreaticnecrosis,infectedpancreaticnecrosis,andpancreaticabscess,whichcanbelife-threatening.Therefore,itisimportanttoidentifyandmonitorhigh-riskpatientsandprovidetimelyandappropriatetreatment.

Oneofthekeyriskfactorsforacutepancreatitisisalcoholabuse.Therefore,measurestopreventandreducealcoholconsumptionareimportantforthepreventionandmanagementofthedisease.Otherriskfactors,suchasgallstonesandhypertriglyceridemia,shouldalsobeaddressedthroughappropriatetreatmentandlifestylemodifications.

Inconclusion,acutepancreatitisisaseriousconditionthatrequirespromptdiagnosisandappropriatemanagement.ERCPandlaparoscopicsurgeryareeffectivetreatmentoptionsforselectedpatients,buttheindicationandtimingoftheoperationshouldbecarefullyevaluatedbasedonthepatient'scondition.Othertreatmentssuchasantibiotics,painrelief,andsupportivecarearealsoimportantforthemanagementofthedisease.Preventionandreductionofriskfactors,suchasalcoholabuseandgallstones,arekeymeasuresforthepreventionandmanagementofacutepancreatitisComplications

Acutepancreatitiscanleadtoseveralcomplicationsthatmaybelife-threatening.Thesecomplicationscanvarydependingontheseverityofthecondition.

1.Acutefluidcollections:Fluidcanaccumulateinandaroundthepancreas,leadingtoswellingandinflammation.Thesefluidcollectionsmayrequiredrainageiftheybecomeinfectedorcausesignificantsymptoms.

2.Pseudocysts:Apseudocystisafluid-filledsacthatformsonornearthepancreasafteranepisodeofpancreatitis.Mostofthesecystswillresolveontheirown,butsomemayrequiredrainageiftheycausesymptomsorbecomeinfected.

3.Necrosis:Severecasesofacutepancreatitismayleadtotissuedeath(necrosis)inthepancreas.Thiscanincreasetheriskofinfectionandmayrequiresurgicalintervention.

4.Sepsis:Sepsisisapotentiallylife-threateningcomplicationthatoccurswhenthebody'simmunesystemoverreactstoaninfection.Inseverecasesofacutepancreatitis,bacteriacanenterthebloodstreamandcausesepsis.Thiscomplicationrequiresurgentmedicalattention.

5.Pancreaticpseudocystinfection:Ifapseudocystbecomesinfected,itcanleadtosepsisandothercomplications.Symptomsofaninfectedpseudocystmayincludefever,abdominalpain,andgeneralmalaise.

Prevention

Preventingacutepancreatitisinvolvesreducingoreliminatingtheriskfactorsthatcanleadtothedevelopmentofthedisease.Somekeymeasuresforpreventioninclude:

1.Avoidingalcoholabuse:Chronicalcoholconsumptionisoneoftheleadingcausesofacutepancreatitis.Limitingoreliminatingalcoholconsumptioncangreatlyreducetheriskofdevelopingthecondition.

2.Maintainingahealthyweight:Obesityisariskfactorforacutepancreatitis.Eatingahealthy,balanceddietandengaginginregularphysicalactivitycanhelpmaintainahealthyweightandreducetheriskofdevelopingthecondition.

3.Managingcholesterollevels:Highlevelsofcholesterolcanleadtothedevelopmentofgallstones,whichisariskfactorforacutepancreatitis.Maintaininghealthycholesterollevelsthroughdietandexercisecanhelpreducetheriskofdevelopinggallstones.

4.Treatingunderlyingmedicalconditions:Certainmedicalconditions,suchashypertriglyceridemia,canincreasetheriskofdevelopingacutepancreatitis.Treatingtheseconditionscanhelpreducetherisk.

Conclusion

Acutepancreatiti