摘要目的:探讨胃下入路腹腔镜治疗感染性胰腺坏死(IPN)的技术要点及其临床疗效。方法:回顾性分析2020年10月至2021年10月间河北医科大学第一医院和第二医院行胃下入路腹腔镜手术治疗的6例重症急性胰腺炎并发IPN患者的临床资料。记录患者的手术时间，术中出血量，术前和术后24 h、3 d、1周生命体征和炎症指标CRP、白细胞计数、中性粒细胞计数以及术后并发症(胰瘘、器官功能衰竭、腹腔出血、腹腔感染、切口感染)发生情况，采用门诊复查方式进行术后随访，记录患者远期并发症。结果:6例IPN患者中男性4例，女性2例，中位年龄50(43.5，56.5)岁。均顺利一次性完成经胃下入路腹腔镜清创手术，手术时间为65(52.5，85)min，术中出血量为20(25，37.5)ml。术前1 d APACHEⅡ评分为11.5(10.25，12.75)分，入院MCTSI评分为8(7，8)分。腹腔镜手术后3 d、1周患者CRP水平、白细胞及中性粒细胞计数较术前明显下降，差异均有统计学意义( P值均<0.05)。并发胰瘘1例，经ERCP给予胰管支架内引流术后好转；切口感染1例，行腹壁切口充分引流后好转；6例均未发生心肺肾等器官功能衰竭、腹腔出血、腹腔感染等并发症。随访期间除1例术前已合并糖尿病，其余5例患者未见新发糖尿病，6例患者均未再发IPN。 结论:胃下入路腹腔镜手术治疗小网膜囊区域的IPN安全有效。

abstractsObjective:To investigate the technical key points and clinical effects of laparoscopic surgery using the subgastric approach for infected pancreatic necrosis (IPN).Methods:From October 2020 to October 2021, The clinical data of 6 patients with IPN after severe acute pancreatitis (SAP) undergoing laparoscopic surgery using the subgastric approach at First Hospital and Second Hospital of Hebei Medical University was retrospectively analyzed. Parameters in this report included the operation time, estimated blood loss, and the patient's vital signs, inflammatory marker CRP, and WBC before operation and postoperative 24 h, 3 d, and 1 w, and postoperative complications including pancreatic leakage, organ failure, bleeding, and abdominal infection and incision infection. Follow-up after surgery was completed in outpatient checkups and long-term complications were recorded.Results:There were 4 male and 2 female patients. The median age of the 6 patients was 50 (43.5, 56.5) years. Laparoscopic debridement surgery using the subgastric approach was successfully completed in all the patients and no reoperation was needed. The median operation time was 65 (52.5, 85) min; the median estimated blood loss was 20 (25, 37.5) ml. Median APACHEⅡ score one day before surgery was 11.5 (10.25, 12.75) and the median MCTSI score at initial admission was 8 (7, 8). The inflammatory parameters including CRP, WBC, and neutrophil count on postoperative day 3 and 1w were significantly lower than those before surgery, and all the differences were statistically significant (all P value <0.05). One patient had a postoperative pancreatic fistula and was alleviated after ERCP with pancreatic stent implantation. Another patient had a incision infection after surgery and recovered after complete surgical drainage of the abdominal wall incision. No patients had complications such as heart, lung, and kidney failure, abdominal hemorrhage and infection. During the follow-up, 5 of 6 patients had no newly-occurred diabetes, except one patient who had diabetes before the operation. None of the 6 patients had recurrent IPN. Conclusions:Laparoscopic surgery using the subgastric approach for infected IPN in lesser omental sac is safe and feasible.