| BackgroundSevere acute pancreatitis(SAP)is a acute abdomen which is abrupt onset,dangerous condition variable,high morbidity and mortality.Laparoscopic peritoneal lavage and drainage(LPLD)is a modus operandi to remove the peripancreatic necrosis and effusion,reduce pancreatic absorption,reduce inflammation and significantly reduce the incidence and mortality of multiple organ failure.However,there was edema and adhesion of the peripancreatic tissueand the anatomical structure was unclearin patientswith the early stage of SAP.Therefore,the SAP patients by early LPLD are still controversial among the current domestic and foreign experts.And how to improve the safety and efficacy of early laparoscopic surgery for the treatment of SAP is still need to continue to explore.CT examination is the first choice for SAP examination with high sensitivity.The CT manifestations of LPLD were correlated with clinical severity,which was an important basis for preoperative evaluation of SAP.The preoperative evaluation of the peripancreatic condition by CT is helpful for the removal of pancreatic necrosis and the precise placement of the peripancreatic vessels.The plain image of CT is difficult to accurately determine the pancreatic necrosis area,the distribution of peripancreatic fluid and the relationship between peripheral blood vessels,so that the operation time is prolonged and the risk is increased.CT multi-planar reconstruction can reconstruct three-dimensional image similar to pancreas and the surrounding through plane image reorganization and reconstruction.Moerover,it makes the evaluation about the pancreatic necrosis area,the relationship and distribution of blood vessels around the peripancreatic effusion is more accurately,so thatit has important clinical significanceto choose the best surgical approach,shorten operation time,reduce surgical injury pancreatic necrosis rate,and ensure the drainage effect.There is no relevant research both here and abroad.Object1.To investigate the clinical effect of early laparoscopic catheter drainage in patients with severe acute pancreatitis.2.To investigate the clinical application of CT multiplannar reformation in patients with severe acute pancreatitisMethodPart 1 Analysis of clinical efficacy of early laparoscopic catheter drainage in patients with severe acute pancreatitisTo retrospectively analyze of the clinical data about 54 cases of severe acute pancreatitis patients under going laparoscopic surgery and catheter drainage in our hospital,to observe the clinical curative effect.CT changes before and after operation were analyzed to observe the relationship between CT changes and clinical efficacy.Part 2 The clinical application of laparoscopic CT tube drainage in the treatment of severe acute pancreatitisTo prospectively analyzethe clinical data about 14 cases of SAP patients undergoing CT multiplannar reformation to guidance for laparoscopic drainage surgery from January 2015 to December 2016,compared with 16 cases of patients with SAP undergoing conventional CT examination from January 2013 to December 2014,and the to explore the clinical value of CT multiplannar reformation to guide laparoscopic drainage.Result1.There were cured in 50 cases,death in 4 cases,and the mortality rate was 7.4%,which was 1 case dead of pancreatic cancer,1 case dead of multiple organ failure,and 2 cases dead of delayed intra-abdominal hemorrhage,andthe average stay was(38.7+24.6)days.12 cases CT showed pancreatic necrosis and residual peripancreatic infection after surgery,1 cases of reoperation,2 cases of delayed intra-abdominal hemorrhage death.The comparison of preoperative and postoperative CT showed that the length of stay in patients with pancreatic necrosis and peripancreatic infection was prolonged,and the difference was statistically significant(P<0.05).2.Compared with the CT conventional scanning group,there was shorteroperation time,less intraoperative bleeding,fewer hospital daysin the CT multiplannar reformation group,complications and mortality rate was statistically significant(P<0.05).Conclusion1、Early laparoscopic catheter drainage treatment of SAP is a safe and effective treatment approach.2.Residual pancreatic necrosis and peripancreatic infection are the main causes of prolonged hospitalization and produce severe complications in patients with SAP after early laparoscopic drainage.3.CT multiplanar reformation guiding catheter drainage in severe acute pancreatitis can improve the safety and effectiveness of laparoscopic surgery. |
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