摘要目的 探讨急诊经胚胎性自然腔道内镜手术(ENOTES)及软式内镜治疗重症急性胰腺炎合并腹腔间隔室综合征(ACS)的价值.方法 SAP合并ACS患者随机分成ENOTES组和外科手术组.在常规治疗基础上,ENOTES组患者入院4h内实施经ENOTES及软式内镜治疗,外科手术组患者入院4h内实施开腹手术治疗.比较两种治疗方法的腹腔压力变化、APACHEⅡ评分、治愈率、并发症.结果 ENOTES组与外科手术组患者手术前腹腔内压力差异无统计学意义(22.57±7.48) cmH 2O(1 cmH 2O=0.098 kPa) vs.(24.000±5.62) cmH 2 O,(P＞0.05).ENOTES组患者术后第1、3、5、7天腹腔内压力是(12.09±5.23) cmH 2O、(9.41 ±3.12) cmH 2O、(7.878±2.24) cmH2O、(7.15±1.34) cmH2O;外科手术组患者术后第1、3、5、7天腹腔内压力是(12.55 ±2.88) cmH2O、(8.82±4.14) cmH 2O、(7.45±2.38) cmH 2O、(7.54±3.18)cmH 2O,两组患者手术后腹腔内压力差异无统计学意义(P＞0.05).ENOTES组与外科手术组手术前APACHEⅡ评分差异无统计学意义(14.82±4.00) vs.(17.00±6.78),(P＞0.05).ENOTES组患者术后第1、3、5、7天APACHEⅡ评分是(10.05 ±2.43)、(8.74±2.48)、(7.18±2.72)、(6.35±2.78).外科手术组患者术后第1、3、5、7天APACHEⅡ评分是(13.38 ±3.12)、(12.92±4.03)、(10.08±3.30)、(9.54±3.18).两组患者手术后APACHEⅡ评分差异具有统计学意义(P＜0.05).ENOTES组治愈率96.8％,外科手术组治愈率78.5％,两组患者治愈率差异具有统计学意义(P＜0.05).ENOTES组并发症12.5％,外科手术组并发症50.0％.两组患者并发症差异具有统计学意义(P＜0.01).结论 急诊ENOTES及软式内镜治疗重症急性胰腺炎合并ACS安全、有效、微创、术后并发症少,值得推广.

abstractsObjective To investigate value of embryonic natural orifice transluminal endoscopic surgery (ENOTES) in the treatment of patients with abdominal compartment syndrome (ACS) complicated by severe acute pancreatitis.Methods The patients with ACS complicated by SAP were,randomly divided into two groups,Group ENOTES and Group surgical operation.On the base of routine therapy the embryonic natural orifice transluminal endoscopic surgery with flexible endoscope was performed for 32 patients with ACS complicated by SAP during 4 hr of admission,whereas,surgical operation was carried out for 28patients with ACS complicated by SAP during 4 hr of admission.Intra-abdominal pressure,changes of APACHE Ⅱ scores,cure rate,and complications between Group ENOTES and Group surgical operation were compared.Results There was no significant difference between Group ENOTES and Group surgical operation in intra-abdominal pressure at admission with (22.57 ± 7.48) cmH2O vs.(24.000 ± 5.62)cmH 2O,(P ＞0.05).Intra-abdominal pressure in Group ENOTES was (12.09 ±5.23) cmH 2O,(9.41±3.12) cmH 2O,(7.87 ±2.24) cmH 2O and (7.15 ± 1.34) cmH 2O at 1st,3rd,5th and 7th day after ENOTES.Compared with Group ENOTES,intra-abdominal pressure in Group surgical operation was (12.55±2.88) cmH 2O,(8.82±4.14) cmH2O,(7.45 ±2.38) cmH 2O,and (7.54±3.18) cmH2O at 1st,3rd,5th and 7th day after surgical operation.There was no statistical differences in intraabdominal pressure after operations between two groups (p ＞ 0.05).At admission there was no significant differences between Group ENOTES and Group surgical operation in the scre of APACHE Ⅱ [(14.82 ± 4.00) vs (17.00 ± 6.78),P ＞ 0.05].The scores of APACHE Ⅱ in Group ENOTES were (10.05 ±2.43),(8.74 ± 2.48),(7.18 ± 2.72) and (6.35 ± 2.78) at 1 st,3rd,5th and 7th day after ENOTES.Compared whth Group ENOTES,the scores of APACHE in Group surgical operation were (13.38 ±3.12),(12.92±4.03),(10.08 ±3.30) and (9.54 ±3.18) at 1st,3rd,5th and 7th day after surgical operation.There was significant differences between two groups in the scores of APACHE after operations (P ＜0.05).The cure rate was 96.8％ in ENOTES group and 78.5％ in surgical operation group.The difference between ENOTES group and surgical operation group in cure rate had significant (P ＜ 0.05).The complications accounted for 12.5％ in ENOTES group and 50.0％ in surgical operation group.There was significantly different between ENOTES group and surgical operation group in the complications.(P ＜0.01).Conclusions Emergency ENOTES with flexible endoscope is a safe,effective,minimal invasive and fewer complication method for patients with ACS associated with severe acute pancreatitis.