Objective: To examine the indications and effects of different surgical approaches in laparoscopic debridement for patients with infected pancreatic necrosis(IPN). Methods: The clinical data of 213 IPN patients treated by laparoscopic debridement at Department of General Surgery,Xuanwu Hospital, Capital Medical University from June 2012 to February 2019 were retrospectively analyzed.The therapeutic effects were summarized and analyzed according to different surgical approaches. There were 123 cases in retroperitoneal approach group, including 73 males and 50 females, aging of (51.3±12.4)years; 59 cases in omental sac approach group, including 32 males and 27 females, aging of (48.3±14.2)years; 23 cases in combined approach group, including 13 males and 10 females,aging of(54.3±19.7)years;8 cases in digestive tract approach group, including 5 males and 3 females, aging of(50.2±12.5)years. Results: The time from onset to operation in retro-peritoneal, omental sac, combined and digestive tract approach groups were (44.3±22.8), (47.3±24.3), (52.6±21.2), (51.2±30.1)days, respectively; the operation time was (52.3±26.4), (64.3±29.2), (82.8±24.7), (78.2±38.1) minutes respectively; the median bleeding volume was 18, 33, 42 and 30 ml, respectively; and the first time to eat after operation was (2.5±1.6),(3.8±1.8),(3.7±2.0),(8.4±3.9) days, respectively. The incidence of complications (Clavien-Dindo grade Ⅲ and above)was 10.6%(13/123),10.2% (6/59),17.4%(4/23),1/8 and the mortality was 4.9%(6/123),3.4%(2/59),4.3%(1/23)and 0,respectively.The overall mortality of all patients was 4.2%(9/213).The levels of inflammatory factors were significantly lower in all groups 7 days after operation than before,and no patients was converted to open surgery. Conclusion: Individualized selection of the optimal laparoscopic debridement approach of pancreatic necrosis plays an important role in improving the efficacy and prognosis of IPN patients.
目的： 探讨不同手术入路在腹腔镜胰腺坏死组织清创中的应用指征及效果。方法： 回顾性分析2012年6月至2019年2月在首都医科大学宣武医院普外科接受腹腔镜胰腺坏死组织清创术治疗的213例感染性胰腺坏死（IPN）患者的病例资料。根据不同手术入路进行分组：腹膜后入路组123例，男性73例，女性50例，年龄（51.3±12.4）岁；网膜囊入路组59例，男性32例，女性27例，年龄（48.3±14.2）岁；联合入路组23例，男性13例，女性10例，年龄（54.3±19.7）岁；消化道入路组8例，男性5例，女性3例，年龄（50.2±12.5）岁。收集各组患者发病至手术时间、手术时间、术中出血量、术后首次进食时间、并发症等临床资料。符合正态分布的计量资料以x±s表示，比较采用配对样本t检验；非正态分布的计量资料以M（Q(R)）表示，组间比较采用秩和检验。结果： 腹膜后、网膜囊、联合、消化道入路组患者发病至手术时间分别为（44.3±22.8）、（47.3±24.3）、（52.6±21.2）、（51.2±30.1） d；手术时间分别为（52.3±26.4）、（64.3±29.2）、（82.8±24.7）、（78.2±38.1 ）min；中位出血量分别为18、33、42、30 ml；术后首次进食时间为（2.5±1.6）、（3.8±1.8）、（3.7±2.0）、（8.4±3.9） d；并发症（Clavien-Dindo Ⅲ级及以上）发生率分别为10.6%（13/123）、10.2%（6/59）、17.4%（4/23）、1/8，病死率分别为4.9%（6/123）、3.4%（2/59）、4.3%（1/23）、0。所有入组患者术后总体病死率为4.2%（9/213），无中转开腹患者。结论： 个体化选择最优腹腔镜胰腺坏死组织清创手术入路对改善IPN患者疗效及预后具有重要作用。.
Keywords: Infected pancreatic necrosis; Laparoscope; Pancreatitis,acute necrotizing; Surgical approach; Surgical procedures, minimally invasive.