• 四川省人民醫(yī)院急診外科（成都，610072）;

【摘要】 目的  探討早期微創(chuàng)腹腔置管灌洗在重癥急性胰腺炎（severe acute pancreatitis，SAP）治療中，對(duì)減輕炎性反應(yīng)的作用。 方法  選擇2007年1月-2009年6月收治的SAP患者56例，隨機(jī)分為早期微創(chuàng)腹腔置管灌洗組（灌洗組，n=28）和常規(guī)治療組（對(duì)照組，n=28）；兩組同時(shí)給予生長(zhǎng)抑素，抑酸，抗感染，保持水、電解質(zhì)及酸堿平衡等綜合治療，灌洗組在常規(guī)治療基礎(chǔ)上早期予以微創(chuàng)腹腔置管灌洗。檢測(cè)兩組治療前及治療后2、5、7 d C反應(yīng)蛋白（C-reactrve protein，CRP）、血清腫瘤壞死因子α（tumor necrosis factor α，TNF-α）、 白細(xì)胞介素6（interleukin，IL-6）、IL-8水平。 結(jié)果  兩組治療前CRP、TNF-α、IL-6、IL-8水平差異無(wú)統(tǒng)計(jì)學(xué)意義（P gt;0.05），治療后2、5、7 d比較差異有統(tǒng)計(jì)學(xué)意義（P lt;0.05）。 結(jié)論  早期微創(chuàng)腹腔置管灌洗操作簡(jiǎn)便易行、創(chuàng)傷小、療效佳，對(duì)減輕SAP所致的全身炎性反應(yīng)具有較好效果，是治療SAP有效方法之一。
【Abstract】 Objective  To explore the effect of the early minimally invasive peritoneal lavage in severe acute pancreatitis (SAP) from Januany 2007 to June 2009. Methods  A total of 56 cases of SAP were randomly divided into early minimally invasive peritoneal lavage group (lavage group, n=28) and conventional treatment group (control group, n=28). The patients were given comprehensive treatment, including somatostatin, acid suppression, anti-infection, and maintaining water, electrolyte, and acid alkali balance.In lavage group, the patients were treated with early minimally invasive peritoneal lavage in addition.The levels of C reactive protein(CRP), serum tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), and interleukin 8(IL-8)were detected before and 2, 5, 7 days after tretment. Results  There was no significant difference in CRP, TNF-α, IL-6, or IL-8 before treament between the two groups (P gt;0.05). There were significant differences in CRP, TNF-α, IL-6, and IL-8 after treatment between the two groups (P lt;0.05). Conclusion  Early minimally invasive peritoneal lavage is a simple, minially invasive, and effective techinique in treating SAP.

引用本文： 胡俊川,馮強(qiáng),高聰,王前清. 早期微創(chuàng)腹腔置管灌洗對(duì)重癥急性胰腺炎炎性反應(yīng)的影響. 華西醫(yī)學(xué), 2010, 25(8): 1433-1435. doi: 復(fù)制

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1. Bank S, Singh P, Pooran N, et al. Evaluation of factors that have reduced mortality from acute pancreatitis over the past 20 years[J]. J Clin Gastroenterol, 2002, 35(1): 50-60.
2. Gross V, Andreesen R, Leser HG, et al. Interleukin-8 and neutrophil activation in acute pancreatitis[J]. Eur J Clin Invest, 1992, 22(3): 200-203.
3. Carroll JK, Herrick B, Gipson T, et al. Acute pancreatitis: diagnosis, prognosis, and treatment[J]. Am Fan physician, 2007, 75(10): 1513-1520.
4. 徐萍, 呂農(nóng)華, 朱萱, 等．重癥急性胰腺炎非手術(shù)治療十年回顧[J]．中華消化雜志, 2004, 24(10): 632-634.
5. 中華醫(yī)學(xué)會(huì)消化病學(xué)分會(huì)胰腺疾病學(xué)組. 中國(guó)急生胰腺炎診治指南(草案)[J]. 胰腺病學(xué), 2004, 4(1): 35-38.
6. 張肇達(dá), 嚴(yán)律南, 劉續(xù)寶. 急性胰腺炎[M]. 北京: 人民衛(wèi)生出版社, 2004: 200.
7. 張圣道, 雷若慶. 重癥急性胰腺炎的診治方案及發(fā)展趨勢(shì)[J]. 中華肝膽外科雜志, 2004, 10(4): 219-220.
8. 秦琦瑜, 李勇, 陳慮. TNF-a與IL-6在大鼠急性重癥胰腺炎并發(fā)全身炎性介質(zhì)反應(yīng)綜合癥中的作用[J]. 河北醫(yī)藥, 2008, 36(2): 140-141.
9. 劉納新, 劉存麗, 施紅旗, 等. 烏司他丁、地塞米松對(duì)急性壞死性胰腺炎大鼠TNF-a、IL-6和GR的影響[J]. 肝膽胰外科雜志, 2008, 20(5): 336-339.
10. Hartwig W, Maksan SM, Foitzik T, et al. Reduction in mortality with delayed surgical theraphy of severe pancreatitis[J]. J Gastrointest Surg, 2002, 6(3): 481-487.
11. 王自法, 徐軍, 潘承恩, 等．地塞米松抑制炎癥遞質(zhì)改善鼠重癥急性胰腺炎的預(yù)后[J]．世界華人消化雜志, 2000, 8(2): 239-239.
12. 王原, 余亮科, 曹克勇. 81例重癥急性胰腺炎臨床分析[J]. 中國(guó)醫(yī)藥, 2008, 3(5): 280-281.
13. Zhang Q, Ni Q, Cai D, et al. Mechanisms of multiple organ damages in acute necrotizing pancreatitis[J]. Chin Med J, 2001, 114(7): 738-742.
14. Oruc N, Ozutemiz AO, Yukselen V, et al. Infliximab: a new therapeutic agent in acute pancreatitis[J]. Pancreas, 2004, 28(1): 1-8.
15. Bhatia M, Brady M, Shokuhi S, et al. Inflammatory mediators in acute pancreatitis[J]. J Pathol, 2000, 190(2): 117-125.
16. Steinberg W, Tenner S. Acute pancreatitis[J]. N Engl J Med, 1994, 330(17): 1198-1220.
17. Inagaki T, Hoshino M, Hayakawa T, et al. Interleukin-6 is a useful marker for early prediction of the severity of acute pancreatitis[J]. Pancreas, 1997(1), 14: 1-8.
18. 孫備, 程年鑫, 姜洪池. 對(duì)重癥急性胰腺炎引流治療的幾點(diǎn)認(rèn)識(shí)[J]. 中國(guó)實(shí)用外科雜志, 2009, 29(11): 907-909.
19. Dugernier TL, Laterre PF, Wint tebole X, et al. Compartmentalization of the inflammatory response during acute pancreatitis: correlation with local and systemic complications[J]. Am J Respir Crit Care Med, 2003, 168(2): 148-157.
20. 李宛霞, 陶少宇, 李玲輝, 等. 腹腔鏡下腹腔灌洗術(shù)對(duì)重癥急性胰腺炎的療效分析[J]. 中國(guó)急救醫(yī)學(xué), 2009, 29(1): 24-26.
21. 袁楚明, 李奕璉. 早期微創(chuàng)腹腔置管灌洗治療重癥急性胰腺炎[J]. 胰腺病學(xué), 2007, 7(6): 378-380.
22. 王崇文. 重癥急性胰腺炎的非手術(shù)治療[J]. 中華消化雜志, 1999, 19(6): 367-368.
  1. 1. Bank S, Singh P, Pooran N, et al. Evaluation of factors that have reduced mortality from acute pancreatitis over the past 20 years[J]. J Clin Gastroenterol, 2002, 35(1): 50-60.
  2. 2. Gross V, Andreesen R, Leser HG, et al. Interleukin-8 and neutrophil activation in acute pancreatitis[J]. Eur J Clin Invest, 1992, 22(3): 200-203.
  3. 3. Carroll JK, Herrick B, Gipson T, et al. Acute pancreatitis: diagnosis, prognosis, and treatment[J]. Am Fan physician, 2007, 75(10): 1513-1520.
  4. 4. 徐萍, 呂農(nóng)華, 朱萱, 等．重癥急性胰腺炎非手術(shù)治療十年回顧[J]．中華消化雜志, 2004, 24(10): 632-634.
  5. 5. 中華醫(yī)學(xué)會(huì)消化病學(xué)分會(huì)胰腺疾病學(xué)組. 中國(guó)急生胰腺炎診治指南(草案)[J]. 胰腺病學(xué), 2004, 4(1): 35-38.
  6. 6. 張肇達(dá), 嚴(yán)律南, 劉續(xù)寶. 急性胰腺炎[M]. 北京: 人民衛(wèi)生出版社, 2004: 200.
  7. 7. 張圣道, 雷若慶. 重癥急性胰腺炎的診治方案及發(fā)展趨勢(shì)[J]. 中華肝膽外科雜志, 2004, 10(4): 219-220.
  8. 8. 秦琦瑜, 李勇, 陳慮. TNF-a與IL-6在大鼠急性重癥胰腺炎并發(fā)全身炎性介質(zhì)反應(yīng)綜合癥中的作用[J]. 河北醫(yī)藥, 2008, 36(2): 140-141.
  9. 9. 劉納新, 劉存麗, 施紅旗, 等. 烏司他丁、地塞米松對(duì)急性壞死性胰腺炎大鼠TNF-a、IL-6和GR的影響[J]. 肝膽胰外科雜志, 2008, 20(5): 336-339.
  10. 10. Hartwig W, Maksan SM, Foitzik T, et al. Reduction in mortality with delayed surgical theraphy of severe pancreatitis[J]. J Gastrointest Surg, 2002, 6(3): 481-487.
  11. 11. 王自法, 徐軍, 潘承恩, 等．地塞米松抑制炎癥遞質(zhì)改善鼠重癥急性胰腺炎的預(yù)后[J]．世界華人消化雜志, 2000, 8(2): 239-239.
  12. 12. 王原, 余亮科, 曹克勇. 81例重癥急性胰腺炎臨床分析[J]. 中國(guó)醫(yī)藥, 2008, 3(5): 280-281.
  13. 13. Zhang Q, Ni Q, Cai D, et al. Mechanisms of multiple organ damages in acute necrotizing pancreatitis[J]. Chin Med J, 2001, 114(7): 738-742.
  14. 14. Oruc N, Ozutemiz AO, Yukselen V, et al. Infliximab: a new therapeutic agent in acute pancreatitis[J]. Pancreas, 2004, 28(1): 1-8.
  15. 15. Bhatia M, Brady M, Shokuhi S, et al. Inflammatory mediators in acute pancreatitis[J]. J Pathol, 2000, 190(2): 117-125.
  16. 16. Steinberg W, Tenner S. Acute pancreatitis[J]. N Engl J Med, 1994, 330(17): 1198-1220.
  17. 17. Inagaki T, Hoshino M, Hayakawa T, et al. Interleukin-6 is a useful marker for early prediction of the severity of acute pancreatitis[J]. Pancreas, 1997(1), 14: 1-8.
  18. 18. 孫備, 程年鑫, 姜洪池. 對(duì)重癥急性胰腺炎引流治療的幾點(diǎn)認(rèn)識(shí)[J]. 中國(guó)實(shí)用外科雜志, 2009, 29(11): 907-909.
  19. 19. Dugernier TL, Laterre PF, Wint tebole X, et al. Compartmentalization of the inflammatory response during acute pancreatitis: correlation with local and systemic complications[J]. Am J Respir Crit Care Med, 2003, 168(2): 148-157.
  20. 20. 李宛霞, 陶少宇, 李玲輝, 等. 腹腔鏡下腹腔灌洗術(shù)對(duì)重癥急性胰腺炎的療效分析[J]. 中國(guó)急救醫(yī)學(xué), 2009, 29(1): 24-26.
  21. 21. 袁楚明, 李奕璉. 早期微創(chuàng)腹腔置管灌洗治療重癥急性胰腺炎[J]. 胰腺病學(xué), 2007, 7(6): 378-380.
  22. 22. 王崇文. 重癥急性胰腺炎的非手術(shù)治療[J]. 中華消化雜志, 1999, 19(6): 367-368.