摘要
目的:探究肠内营养联合经腹腔穿刺器(Trocar)置双套管引流治疗克罗恩病(Crohn's disease,CD)合并腹腔脓肿的效果分析。方法:采用描述性病例系列研究方法,回顾性收集2018年6月至2022年12月南京明基医院肠瘘与腹腔感染中心收治的肠内营养联合Trocar穿刺置双套管引流治疗克罗恩病合并腹腔脓肿的病人的临床资料。收集病人穿刺前及穿刺后1、3和7天的白细胞计数、降钙素原(PCT)、C反应蛋白(CRP)等指标,比较病人穿刺前后相关指标的变化情况。结果:19例CD合并腹腔脓肿病人均顺利完成CT定位Trocar穿刺置双套管引流的治疗,并经瘘道造影证实存在肠瘘。所有病人均未出现穿刺后穿刺点感染、新发肠瘘及腹腔出血。病人治疗时长为58.3(14,300)d。10例病人经肠内营养联合双套管引流治疗后自愈,9例病人最终因肠瘘行手术治疗。病人穿刺后1d,3d和7d的WBC水平较穿刺前下降(P<0.05);血清CRP穿刺后1d较穿刺前显著升高(P<0.05),穿刺后3d和7d较穿刺前显著下降(P<0.05)。血清降钙素原水平穿刺后较穿刺前差异不存在统计学意义(P>0.05)。结论:肠内营养联合Trocar穿刺置双套管引流安全可行,可有效治疗克罗恩病合并腹腔脓肿。
Objective:To investigate the efficacy of enteral nutrition combined with trocar puncture with a sump drain in the treatment of Crohn’s disease(CD)complicated by intra-abdominal abscess.Methods:A descriptive case series study was conducted.Clinical data of CD patients with intra-abdominal abscess who received enteral nutrition and trocar puncture with a sump drain at the Intestinal Fistula and Intra-abdominal Infection Center of Nanjing BenQ Hospital between June 2018 and December 2022 were retrospectively collected.Laboratory parameters,including white blood cell(WBC)count,C-reactive protein(CRP),and procalcitonin(PCT),were recorded at baseline(pre-puncture)and on days 1,3,and 7 post-puncture.Changes in clinical indicators before and after intervention were compared.Results:All 19 CD patients with intra-abdominal abscess successfully underwent CT-guided trocar puncture with a sump drain,with fistulography confirming the presence of intestinal fistula.No post-procedural complications,including puncture site infection,new-onset intestinal fistula or intra-abdominal hemorrhage,were observed.The median treatment duration was 58.3 days(range:14~300 days).10 patients achieved spontaneous healing while 9 eventually underwent surgical intervention for unresolved fistulas.Post-puncture WBC levels decreased significantly on days 1,3,and 7 compared to baseline(P<0.05).Serum CRP levels increased markedly on day 1 post-puncture(P<0.05)but declined significantly by days 3 and 7(P<0.05).No statistically significant difference was observed in serum procalcitonin levels before and after puncture(P>0.05).Conclusion:The combination of enteral nutrition and trocar puncture with a sump drain is safe,feasible,and effective for managing CD complicated by intra-abdominal abscess.
作者
李梦璇
李伟杰
徐丹丹
陈松林
范朝刚
赵云
LI Meng-xuan;LI Wei-jie;XU Dan-dan;CHEN Song-lin;FAN Chao-gang;ZHAO Yun(Nanjing Medical University Affiliated BenQ Hospital,Center for Intestinal Fistula and Intra-Abdominal Infections,Nanjing 210019,Jiangsu,China;The First Affiliated Hospital with Nanjing Medical University Department of Rehabilitation Medicine Nanjing 212028,Jiangsu,China;Clinical Translational Research Center for Surgical Infection and Immunity of Nanjing Medical University,Nanjing 210019,Jiangsu,China)
出处
《肠外与肠内营养》
北大核心
2025年第3期146-150,共5页
Parenteral & Enteral Nutrition
基金
南京市卫生科技发展项目(YKK22253)。
