湖南省常德市第一人民医院 肝胆外科，湖南 常德 415003
Department of Hepatobiliary Surgery, the First People's Hospital of Changde City, Changde, Hunan 415003, China
背景与目的 近年来多学科协作的综合治疗在重症急性胰腺炎（SAP）治疗方面取得了一定进展，但感染性胰腺坏死（IPN）仍是SAP治疗公认的难点，也是影响SAP疗效的关键。本研究分析总结小切口联合内镜微创手术治疗IPN的临床疗效。方法 回顾性分析2019年6月—2021年6月湖南省常德市第一人民医院肝胆外科收治的9例行小切口联合内镜微创手术治疗的IPN患者临床资料。结果 9例患者中，男性7例，女性2例；平均年龄（46.7±11.6）岁；5例为高脂血症性胰腺炎、2例胆源性胰腺炎、2例酒精性胰腺炎；脓液细菌真菌培养阳性率为77.8%（7/9）。9例患者均顺利完成小切口联合内镜微创手术，4例经左侧腹膜后入路、3例经腹腔小网膜囊入路及2例联合入路。胰腺炎起病到首次手术时间（47.2±10.1）d，术后住院时间（20.4±9.6）d，总住院时间（36.1±18.1）d，手术时间（151.7±55.2）min；清除坏死组织量（240.0±119.6）g；术中出血量（55.4±44.2）mL；放置引流管数量中位数4（3~6）根。8例患者一次手术治愈，1例患者术后再次行经皮胰周脓肿穿刺置管引流术和胆道镜手术治疗；术后2例患者出现主要并发症，包括1例腹腔出血、1例结肠瘘。9例患者均顺利出院，无死亡病例。结论 小切口联合内镜微创手术结合了多种微创技术优点，良好地平衡了清创效率和手术创伤之间的矛盾，在高效彻底清除坏死组织的同时，也保障患者的手术安全性，值得进一步推广。
Background and Aims In recent years, comprehensive treatment through multidisciplinary collaboration has made some progress in the management of severe acute pancreatitis (SAP). However, infected pancreatic necrosis (IPN) is still a recognized challenge in the treatment of SAP and is also critical to the treatment efficacy of SAP. This study was to analyze and summarize the clinical efficacy of small incision combined with endoscopic minimally invasive surgery in the treatment of IPN.Methods The clinical data of 9 patients with IPN receiving the treatment of small incision combined with endoscopic minimally invasive surgery in the Department of Hepatobiliary Surgery of Changde First People's Hospital from June 2019 to June 2021 were retrospectively analyzed.Results Of the 9 patients, 7 were males and 2 were females, with an average age of (46.7±11.6) years; 5 cases were hyperlipidemic pancreatitis, 2 cases were biliary pancreatitis and 2 cases were alcoholic pancreatitis; the positive rate of the bacterial and fungal culture of pus was 77.8% (7/9). Small incision combined with endoscopic minimally invasive surgery was completed in all patients, which was performed via the left retroperitoneal approach in 4 cases, via the small omental sac approach in 3 cases, and the combined approach in 2 cases. The time from the onset of pancreatitis to the first operation was (47.2±10.1) d, the length of postoperative hospital stay was (20.4±9.6) d, the total length of hospital stay was (36.1±18.1) d, the operative time was (151.7±55.2) min, the weight of necrotic tissue removed was (240.0±119.6) g, the volume of intraoperative blood loss was (55.4±44.2) mL, and the median number of drainage tubes placed was 4 (3-6). Eight patients were cured by one session of surgery, and one patient underwent percutaneous drainage of peripancreatic abscess and choledochoscopic operation again after the first operation. Postoperative complications occurred in 2 patients, including one case of abdominal hemorrhage and one case of colonic fistula. All 9 patients were uneventfully discharged smoothly, and no death occurred.Conclusion Small incision combined with minimally invasive endoscopic surgery integrates the advantages of multiple minimally invasive techniques, which balances the contradiction between debridement efficiency and surgical trauma. It can efficiently and thoroughly remove the necrotic tissues while ensuring the safety of patients at the same time. So, it is recommended to be promoted.