Application of Minimally Invasive Technique to Every Stage of Severe Acute Pancreatitis (Report of 101 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YAN Yong ¹ , ZHONG Ping ² , YAN Hongtao ¹ , WANG Tao ¹ , TANG Lijun ¹ , ZHANG Sheng ¹

1.Department of Hepatopancreatobiliary Surgery, General Surgery Center of PLA, Chengdu Military General Hospital, Chengdu 610083, China;;
2.Nursing Department, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610083, China;

Corresponding author：

Keywords：

Severe acute pancreatitis; Minimally invasive technique; Endoscopic retrograde cholangiopancreatograpy; Endoscopic sphincterotomy; Debridement under choledochoscope

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Objective To explore and summarize the application of minimally invasive technique to every stage of severe acute pancreatitis (SAP).
Methods The treatment of 101 SAP patients admitted to our hospital between January 1995 and December 2008 were retrospectively analyzed. After calculi were removed by endoscopic retrograde cholangiopancreatograpy (ERCP) and endoscopic sphincterotomy (EST), endoscopic nasobiliary drainage (ENBD) were applied, then rhubarb liquid was perfused into gut with a nutrient canal and ultrasound-guided abdominal drainage tube were simultaneously placed at the early stage. Some patients received continuous renal replacement therapy (CRRT) at the same time. Laparoscopic cholecystectomy (LC) was performed at the subacute stage, and choledochoscope was introduced to remove parapancreatic necrotic tissues at the late stage of SAP.
Results Of all the 101 cases treated by the method mentioned above, 75 cases received ERCP (or EST) and ENBD, and 31 cases underwent rhubarb liquid perfusion with a nutrient canal. Eight cases underwent continuous renal replacement therapy (CRRT). Forty-eight cases underwent LC and ultrasoundguided abdominal drainage. Thirtysix cases with infected peripancreatic tissue or abscess underwent debridement under choledochoscope 3 to 14 times at the later stage. Five cases died of multiple organ failure (MOF) and acute respiratory distress syndrome (ARDS). The hemobilia ocurred in 2 patients during choledochoscopy and was cured under direct visualization by electric coagulation. Intestinal fistula happened in 3 cases and cured by drainage. Pancreatic pseudocyst was latterly seen in 3 cases and treated by the anastomosis of cyst with jejunum through selective operation. After the hospitalization of 9-132 d (mean 24 d), 96 cases completely recovered.
Conclusion Timely application of minimally invasive technique to every stage of SAP can avoid the defects of traditional operations, decrease the injury and interference to the maximum, and raise the cure rate.

Citation： YAN Yong ,ZHONG Ping,YAN Hongtao,WANG Tao,TANG Lijun,ZHANG Sheng. Application of Minimally Invasive Technique to Every Stage of Severe Acute Pancreatitis (Report of 101 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(8): 816-819. doi: Copy

1.	龚锦文, 周桂霞, 王惠玲. 早期临床干预策略在阻断胰腺炎重症化进程中的作用 [J]. 中国普外基础与临床杂志, 2009; 16(10): 838840.
2.	中华医学会消化病学分会胰腺疾病学组. 中国急性胰腺炎诊治指南(草案) [J]. 中国消化内镜, 2007; 1(10): 3033.
3.	田伏洲, 张丙印, 黎冬暄, 等. 内镜胆管减压治疗急性胰腺炎20年探索与思考 [J]. 中国实用外科杂志, 2005; 25(6): 347349.
4.	张炳印, 田伏洲, 胡兵, 等. 内镜下针状刀乳头括约肌切开术476例分析 [J]. 中华消化内镜杂志, 2001; 18(2): 9798.
5.	孔瑞, 孙备. 重症急性胰腺炎微创治疗的研究进展 [J]. 国外医学外科学分册, 2005; 32(6): 426429.
6.	秦仁义, 夏睿娟, 常青. 胆源性胰腺炎中胆道结石处理方式和时机的探讨 [J]. 中国实用外科杂志, 2004; 24(4): 227228.
7.	张圣道, 雷若庆. 重症急性胰腺炎的诊治方案及发展趋势[J]. 中华肝胆外科杂志, 2004; 10(4): 219200.
8.	Jover R, Llach J, Bordas JM, et al. The usefulness of the timeliness of endoscopic sphincterotomy in severe acute pancreatitis of biliary origin[J]. Gastroenterol Hepatol, 1997; 20(7): 344346.
9.	刁永鹏, 陈宏, 李非. 重症急性胰腺炎肠屏障功能障碍的研究进展[J]. 中国普外基础与临床杂志, 2009; 16(7): 588592.
10.	吴承堂, 黎沾良, 黄祥成, 等. 中药清胰汤及双歧杆菌合剂对急性坏死性胰腺炎肠道细菌移位影响的比较研究[J]. 中国急救医学, 1999; 19(11): 665666.
11.	刁永鹏, 李非, 陈宏, 等. 理气通下合剂对急性胰腺炎患者肠屏障功能障碍的影响 [J].中国普外基础与临床杂志, 2009; 16(8): 637640.
12.	袁楚明, 李奕琏. 早期微创腹腔置管灌洗治疗重症急性胰腺炎 [J]. 胰腺病学, 2007; 7(6): 378380.
13.	纪涛, 汤志刚. 微创介入联合血液滤过治疗重症急性胰腺炎进展[J]. 肝胆外科杂志, 2008; 16(5): 395398.
14.	姚欣敏, 刘牧, 李云涛, 等. 早期反复间断血滤治疗重症急性胰腺炎的临床研究 [J]. 中国普外基础与临床杂志, 2008; 15(5): 352357.
15.	卢海武, 彭和平, 薛平, 等. 十二指肠镜联合超声腹腔镜微创治疗急性胆源性胰腺炎 [J]. 中国内镜杂志, 2004; 10(6): 100102.
16.	朱强华, 姚昌宏, 高志光, 等. 急性结石性胆源性胰腺炎治疗方式和手术时机探讨 [J]. 肝胆胰外科杂志, 2006; 18(4): 248249.
17.	冯志, 陈惠根. 两镜治疗急性胆源性胰腺炎的体会 [J]. 实用临床医学, 2003; 4(6): 1618.
18.	周总光, 袁朝新, 孙炜, 等. 重症急性胰腺炎腹腔镜手术治疗的临床研究 [J]. 中华外科杂志, 2001; 39(4): 272274.
19.	区应亮, 区金锐, 陈伟, 等. 微创技术在治疗急性重症胰腺炎中的应用 [J]. 实用医学杂志, 2004; 20(10): 11161117.
20.	石欣, 高乃荣, 郭庆明, 等. 外科治疗急性坏死性胰腺炎-14年经验总结 [J]. 中国现代普通外科进展, 2006; 9(4): 239242.
21.	姚欣敏, 于澜, 张抒, 等. CT引导下经皮穿刺诊治重症急性胰腺炎局部并发症的临床研究（附43例报道） [J].中国普外基础与临床杂志, 2008; 15(8): 560563.
22.	汪涛, 汤礼军, 田伏洲, 等. 介入超声穿刺引流联合胆道镜清创: 胰周坏死感染的微创化解决方案 [J]. 中华外科杂志, 2008; 46(21): 16301633.
23.	黎冬暄, 田伏洲, 张炳印, 等. 胆道镜再清创治疗胰腺周围脓肿 [J]. 中华消化外科杂志, 2008; 7(6): 463464.

1. 龚锦文, 周桂霞, 王惠玲. 早期临床干预策略在阻断胰腺炎重症化进程中的作用 [J]. 中国普外基础与临床杂志, 2009; 16(10): 838840.
2. 中华医学会消化病学分会胰腺疾病学组. 中国急性胰腺炎诊治指南(草案) [J]. 中国消化内镜, 2007; 1(10): 3033.
3. 田伏洲, 张丙印, 黎冬暄, 等. 内镜胆管减压治疗急性胰腺炎20年探索与思考 [J]. 中国实用外科杂志, 2005; 25(6): 347349.
4. 张炳印, 田伏洲, 胡兵, 等. 内镜下针状刀乳头括约肌切开术476例分析 [J]. 中华消化内镜杂志, 2001; 18(2): 9798.
5. 孔瑞, 孙备. 重症急性胰腺炎微创治疗的研究进展 [J]. 国外医学外科学分册, 2005; 32(6): 426429.
6. 秦仁义, 夏睿娟, 常青. 胆源性胰腺炎中胆道结石处理方式和时机的探讨 [J]. 中国实用外科杂志, 2004; 24(4): 227228.
7. 张圣道, 雷若庆. 重症急性胰腺炎的诊治方案及发展趋势[J]. 中华肝胆外科杂志, 2004; 10(4): 219200.
8. Jover R, Llach J, Bordas JM, et al. The usefulness of the timeliness of endoscopic sphincterotomy in severe acute pancreatitis of biliary origin[J]. Gastroenterol Hepatol, 1997; 20(7): 344346.
9. 刁永鹏, 陈宏, 李非. 重症急性胰腺炎肠屏障功能障碍的研究进展[J]. 中国普外基础与临床杂志, 2009; 16(7): 588592.
10. 吴承堂, 黎沾良, 黄祥成, 等. 中药清胰汤及双歧杆菌合剂对急性坏死性胰腺炎肠道细菌移位影响的比较研究[J]. 中国急救医学, 1999; 19(11): 665666.
11. 刁永鹏, 李非, 陈宏, 等. 理气通下合剂对急性胰腺炎患者肠屏障功能障碍的影响 [J].中国普外基础与临床杂志, 2009; 16(8): 637640.
12. 袁楚明, 李奕琏. 早期微创腹腔置管灌洗治疗重症急性胰腺炎 [J]. 胰腺病学, 2007; 7(6): 378380.
13. 纪涛, 汤志刚. 微创介入联合血液滤过治疗重症急性胰腺炎进展[J]. 肝胆外科杂志, 2008; 16(5): 395398.
14. 姚欣敏, 刘牧, 李云涛, 等. 早期反复间断血滤治疗重症急性胰腺炎的临床研究 [J]. 中国普外基础与临床杂志, 2008; 15(5): 352357.
15. 卢海武, 彭和平, 薛平, 等. 十二指肠镜联合超声腹腔镜微创治疗急性胆源性胰腺炎 [J]. 中国内镜杂志, 2004; 10(6): 100102.
16. 朱强华, 姚昌宏, 高志光, 等. 急性结石性胆源性胰腺炎治疗方式和手术时机探讨 [J]. 肝胆胰外科杂志, 2006; 18(4): 248249.
17. 冯志, 陈惠根. 两镜治疗急性胆源性胰腺炎的体会 [J]. 实用临床医学, 2003; 4(6): 1618.
18. 周总光, 袁朝新, 孙炜, 等. 重症急性胰腺炎腹腔镜手术治疗的临床研究 [J]. 中华外科杂志, 2001; 39(4): 272274.
19. 区应亮, 区金锐, 陈伟, 等. 微创技术在治疗急性重症胰腺炎中的应用 [J]. 实用医学杂志, 2004; 20(10): 11161117.
20. 石欣, 高乃荣, 郭庆明, 等. 外科治疗急性坏死性胰腺炎-14年经验总结 [J]. 中国现代普通外科进展, 2006; 9(4): 239242.
21. 姚欣敏, 于澜, 张抒, 等. CT引导下经皮穿刺诊治重症急性胰腺炎局部并发症的临床研究（附43例报道） [J].中国普外基础与临床杂志, 2008; 15(8): 560563.
22. 汪涛, 汤礼军, 田伏洲, 等. 介入超声穿刺引流联合胆道镜清创: 胰周坏死感染的微创化解决方案 [J]. 中华外科杂志, 2008; 46(21): 16301633.
23. 黎冬暄, 田伏洲, 张炳印, 等. 胆道镜再清创治疗胰腺周围脓肿 [J]. 中华消化外科杂志, 2008; 7(6): 463464.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of Minimally Invasive Technique to Every Stage of Severe Acute Pancreatitis (Report of 101 Cases)

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