经横结肠系膜入路在腹腔镜感染性胰腺坏死 清创术中的临床疗效分析

Clinical Efficacy Analysis of the Transmesocolic Approach in Laparoscopic Debridement and Drainage for Infected Pancreatic Necrosis

摘要: 目的：探讨不同腹腔镜清创手术入路对感染性胰腺坏死(IPN)患者临床疗效的影响。方法：回顾性分析2022年1月至2025年12月期间接受腹腔镜感染性胰腺坏死清创术的77例IPN患者临床资料。根据手术入路分为经横结肠系膜组(n = 35)和经胃结肠韧带组(n = 42)，比较两组患者围手术期实验室指标、手术时间、术中出血量、术后住院时间、并发症发生率及医疗费用。结果：与经胃结肠韧带入路相比，经横结肠系膜入路患者手术时间显著缩短(131.4 ± 16.8 min vs. 160.1 ± 18.6 min, P < 0.001)，术中出血量明显减少(193.1 ± 31.9 mL vs. 239.3 ± 42.1 mL, P < 0.001)，且住院费用显著降低(42296.7 ± 14843.3元vs. 68090.9 ± 25999.0元，P < 0.001)。但经横结肠系膜组术后引流管留置时间呈延长趋势(7.86 ± 2.33天vs. 6.21 ± 2.51天，P = 0.366)。术后第3天，两组间血清淀粉酶(242.6 ± 140.3 U/L vs. 257.0 ± 97.3 U/L, P = 0.434)与脂肪酶水平(221.3 ± 55.0 U/L vs. 241.8 ± 63.8 U/L, P = 0.445)无统计学差异。在主要术后并发症(如胃肠瘘、出血、手术部位感染、多器官功能障碍综合征)发生率及总体预后(好转/治愈率：94.3% vs. 90.5%, P = 0.535)方面，两组亦无显著差异；然而经横结肠系膜组其他并发症发生率呈现较低趋势(2.9% vs.14.3%, P > 0.05)。结论：经横结肠系膜入路腹腔镜清创术在提高手术效率、减少术中出血、控制医疗成本方面具有显著优势，且未增加术后主要并发症，可能为IPN患者提供一种更具效益的微创治疗选择。其远期疗效及安全性仍需大样本前瞻性研究进一步验证。

Abstract: Objective: To investigate the impact of different laparoscopic debridement surgical approaches on the clinical efficacy of patients with infectious pancreatic necrosis (IPN). Methods: The clinical data of 77 patients with IPN who underwent laparoscopic debridement surgery from January 2022 to December 2025 were retrospectively analyzed. The patients were divided into the trans-mesocolic group (n = 35) and the trans-gastrocolic ligament group (n=42) based on the surgical approach. The perioperative laboratory indicators, operation time, intraoperative blood loss, postoperative hospital stay, complication rate, and medical expenses were compared between the two groups. Results: Compared with the trans-gastrocolic ligament approach, the operation time of patients in the trans-mesocolic approach was significantly shorter (131.4 ± 16.8 min vs. 160.1 ± 18.6 min, P < 0.001), intraoperative blood loss was significantly reduced (193.1 ± 31.9 mL vs. 239.3 ± 42.1 mL, P < 0.001), and hospitalization costs were significantly lower (42296.7 ± 14843.3 yuan vs. 68090.9 ± 25999 yuan, P < 0.001). However, the postoperative drainage tube retention time in the trans-mesocolic group showed a prolonged trend (7.86 ± 2.33 days vs. 6.21 ± 2.51 days, P = 0.366). On the third postoperative day, there was no statistically significant difference in serum amylase (242.6 ± 140.3 U/L vs. 257.0 ± 97.3 U/L, P = 0.434) and lipase levels (221.3 ± 55.0 U/L vs. 241.8 ± 63.8 U/L, P = 0.445) between the two groups. There were no significant differences in the incidence of major postoperative complications (such as gastrointestinal fistula, bleeding, surgical site infection, multiple organ dysfunction syndrome) and overall prognosis (improvement/cure rate: 94.3% vs. 90.5%, P = 0.535) between the two groups; however, the incidence of other complications in the trans-mesocolic group showed a lower trend (2.9% vs. 14.3%, P > 0.05). Conclusion: The trans-mesocolic approach laparoscopic debridement surgery has significant advantages in improving surgical efficiency, reducing intraoperative blood loss, and controlling medical costs, without increasing major postoperative complications. It may provide a more cost-effective minimally invasive treatment option for patients with IPN. The long-term efficacy and safety still need to be further verified by large-sample prospective studies.