腹腔镜术后腹腔灌洗、持续循环式腹膜透析治疗重症急性胰腺炎的临床研究
|
摘要
目的观察腹腔镜术后腹腔灌洗、持续循环式腹膜透析(CCPD)治疗重症急性胰腺炎(SAP)的临床效果及安全性。方法将68例SAP患者随机分为治疗组32例与对照组36例,治疗组于腹腔镜下手术,术后灌洗引流与CCPD交替进行,病情稳定后(约需3 d)单一行腹腔灌洗;对照组给予常规治疗。结果治疗组急性生理与慢性健康评分(APACHEⅡ)及Balthazar CT积分从第1天即下降明显(P<0.05),而对照组在第3天才显著下降,且治疗组各时点积分均较对照组明显降低(P<0.05)。治疗组各时相点血浆中促炎细胞因子肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)及C反应蛋白(CRP)含量与治疗前比较呈明显降低趋势(P<0.01),白细胞介素-10(IL-10)含量呈明显升高趋势(P<0.01),与对照组比较各时点各细胞因子含量差异有统计学意义意义(P<0.05)。结论腹腔镜术后灌洗引流与CCPD治疗SAP具有方法简单、安全、快捷、创伤小、并发症少及无需抗凝等优点,无血液动力学影响,患者有较好的耐受性等特点,是一种治疗SAP的有效方法。
Objective To investigate the clinical effects and safety of peritoneal lavage and continuous circular peritoneal dialysis(CCPD) after laparoscopic operation in treatment of severe acute pancreatitis(SAP). Methods 68 patients of SAP were randomly divided into treatment group and control group. 32 cases of treatment group were performed laparoscopic operation, and then treated with peritoneal lavage and continuous circular peritoneal dialysis alternatively. When the patient's condition was stable and serum amylase reduce to normal, only peritoneal lavage was used in the treatment. 36 cases of control group were treated with regular methods. Results The operation time,the hemorrhage amount of operation, the recovery time of serum index and the incidence of complication after operation were significantly decreased compared with those of the contrast group. The CT scores and APACHE Ⅱscores were significantly decreased on the first day in microtraumatic group and on third day in control group, and the scores on each observation point in microtraumatic group were lower than those in control group. The serum levels of proinflammatory cytokines TNF-α、IL-6、IL-8 and CRP were significantly decreased and the serum level of antiinflammatory cytokines IL-10 was significantly increased significantly after treatment in both groups. But the serum TNF-α、IL-6、IL-8 and CRP levels were higher and the serum IL-10 level was lower on each observation points in microtraumatic group than those in control group. Conclusions Peritoneal lavage and continuous circular peritoneal dialysis after laparoscopic operation is a simple, safe, quick, less traumatic, few complicated, no anticoagulant, easy tolerated and effective method in the treatment of severe acute pancreatitis.
Objective To investigate the clinical effects and safety of peritoneal lavage and continuous circular peritoneal dialysis(CCPD) after laparoscopic operation in treatment of severe acute pancreatitis(SAP). Methods 68 patients of SAP were randomly divided into treatment group and control group. 32 cases of treatment group were performed laparoscopic operation, and then treated with peritoneal lavage and continuous circular peritoneal dialysis alternatively. When the patient's condition was stable and serum amylase reduce to normal, only peritoneal lavage was used in the treatment. 36 cases of control group were treated with regular methods. Results The operation time,the hemorrhage amount of operation, the recovery time of serum index and the incidence of complication after operation were significantly decreased compared with those of the contrast group. The CT scores and APACHE Ⅱscores were significantly decreased on the first day in microtraumatic group and on third day in control group, and the scores on each observation point in microtraumatic group were lower than those in control group. The serum levels of proinflammatory cytokines TNF-α、IL-6、IL-8 and CRP were significantly decreased and the serum level of antiinflammatory cytokines IL-10 was significantly increased significantly after treatment in both groups. But the serum TNF-α、IL-6、IL-8 and CRP levels were higher and the serum IL-10 level was lower on each observation points in microtraumatic group than those in control group. Conclusions Peritoneal lavage and continuous circular peritoneal dialysis after laparoscopic operation is a simple, safe, quick, less traumatic, few complicated, no anticoagulant, easy tolerated and effective method in the treatment of severe acute pancreatitis.
引文
[1]FENG C,LI B,WANG L L,et al.Effect of peritoneal lavage with ulinastatin on the expression of NF-κB and TNF-αin multiple organs of rats with severe acute pancreatitis[J].Exp Ther Med,2015,10(6):2029-2034.
[2]WANG X Y,TANG Q Q,ZHANG J L,et al.Effect of SB203580on pathologic change of pancreatic tissue and expression of TNF-αand IL-1βin rats with severe acute pancreatitis[J].Eur Rev Med Pharmacol Sci,2014,18(3):338-343.
[3]GUO J,HUANG W,YANG X N,et al.Short-term continuous high-volume hemofiltration on clinical outcomes of severe acute pancreatitis[J].Pancreas,2014,43(2):250-254.
[4]SUN S,HE L,BAI M,et al.High-volume hemofiltration plus hemoperfusion for hyperlipidemic severe acute pancreatitis:a controlled pilot study[J].Ann Saudi Med,2015,35(5):352-358.
[5]鲍鹰,朱鸣,冯文明,等.短时血液滤过联合腹膜透析治疗急性重症胰腺炎[J].中华急诊医学杂志,2004,13(7):460-461.
[6]中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].中华外科杂志,2015,53(1):50-53.
[7]WANG Y,LIU W,LIU X,et al.Role of liver in modulating the release of inflammatory cytokines involved in lung and multiple organ dysfunction in severe acute pancreatitis[J].Cell Biochem Biophys,2015,71(2):765-776.
[8]MERZA M,HARTMAN H,RAHMAN M,et al.Neutrophil extracellular traps induce trypsin activation,inflammation,and tissue damage in mice with severe acute pancreatitis[J].Gastroenterology,2015,149(7):1920-1931.
[9]NIEMINEN A,MAKSIMOW M,MENTULA P,et al.Circulating cytokines in predicting development of severe acute pancreatitis[J].Crit Care,2014,18(3):R104.
[10]LUAN Z G,ZHANG J,YIN X H,et al.Ethyl pyruvate significantly inhibits tumour necrosis factor-α,interleukin-1βand high mobility group box 1 releasing and attenuates sodium taurocholate-induced severe acute pancreatitis associated with acute lung injury[J].Clin Exp Immunol,2013,172(3):417-426.
[11]SURBATOVIC M,RADAKOVIC S.Tumor necrosis factor-αlevels early in severe acute pancreatitis:is there predictive value regarding severity and outcome[J].J Clin Gastroenterol,2013,47(7):637-643.
[12]DUININCK T M,LIBSCH K D,UENO T,et al.Infected pancreatic necrosis[J].Prob General Surg,2002,19(1):72-80.
[13]王自明,林伶,何剪太,等.重症急性胰腺炎内镜微创综合治疗的临床分析[J].中国内镜杂志,2013,19(9):961-964.
[14]MATSUMOTO K,MIYAKE Y,NAKATSU M,et al.Usefulness of early-phase peritoneal lavage for treating severe acute pancreatitis[J].Intern Med,2014,53(1):1-6.
[15]YANG C,GUANGHUA F,WEI Z,et al.Combination of hemofiltration and peritoneal dialysis in the treatment of severe acute pancreatitis[J].Pancreas,2010,39(1):16-19.
[2]WANG X Y,TANG Q Q,ZHANG J L,et al.Effect of SB203580on pathologic change of pancreatic tissue and expression of TNF-αand IL-1βin rats with severe acute pancreatitis[J].Eur Rev Med Pharmacol Sci,2014,18(3):338-343.
[3]GUO J,HUANG W,YANG X N,et al.Short-term continuous high-volume hemofiltration on clinical outcomes of severe acute pancreatitis[J].Pancreas,2014,43(2):250-254.
[4]SUN S,HE L,BAI M,et al.High-volume hemofiltration plus hemoperfusion for hyperlipidemic severe acute pancreatitis:a controlled pilot study[J].Ann Saudi Med,2015,35(5):352-358.
[5]鲍鹰,朱鸣,冯文明,等.短时血液滤过联合腹膜透析治疗急性重症胰腺炎[J].中华急诊医学杂志,2004,13(7):460-461.
[6]中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].中华外科杂志,2015,53(1):50-53.
[7]WANG Y,LIU W,LIU X,et al.Role of liver in modulating the release of inflammatory cytokines involved in lung and multiple organ dysfunction in severe acute pancreatitis[J].Cell Biochem Biophys,2015,71(2):765-776.
[8]MERZA M,HARTMAN H,RAHMAN M,et al.Neutrophil extracellular traps induce trypsin activation,inflammation,and tissue damage in mice with severe acute pancreatitis[J].Gastroenterology,2015,149(7):1920-1931.
[9]NIEMINEN A,MAKSIMOW M,MENTULA P,et al.Circulating cytokines in predicting development of severe acute pancreatitis[J].Crit Care,2014,18(3):R104.
[10]LUAN Z G,ZHANG J,YIN X H,et al.Ethyl pyruvate significantly inhibits tumour necrosis factor-α,interleukin-1βand high mobility group box 1 releasing and attenuates sodium taurocholate-induced severe acute pancreatitis associated with acute lung injury[J].Clin Exp Immunol,2013,172(3):417-426.
[11]SURBATOVIC M,RADAKOVIC S.Tumor necrosis factor-αlevels early in severe acute pancreatitis:is there predictive value regarding severity and outcome[J].J Clin Gastroenterol,2013,47(7):637-643.
[12]DUININCK T M,LIBSCH K D,UENO T,et al.Infected pancreatic necrosis[J].Prob General Surg,2002,19(1):72-80.
[13]王自明,林伶,何剪太,等.重症急性胰腺炎内镜微创综合治疗的临床分析[J].中国内镜杂志,2013,19(9):961-964.
[14]MATSUMOTO K,MIYAKE Y,NAKATSU M,et al.Usefulness of early-phase peritoneal lavage for treating severe acute pancreatitis[J].Intern Med,2014,53(1):1-6.
[15]YANG C,GUANGHUA F,WEI Z,et al.Combination of hemofiltration and peritoneal dialysis in the treatment of severe acute pancreatitis[J].Pancreas,2010,39(1):16-19.