探讨肾镜治疗重症急性胰腺炎包裹性坏死（WON）内引流术后感染的应用价值。

回顾性分析2010年1月至2016年2月在中国人民解放军总医院5例将WON作为胰腺假性囊肿行内引流术后引起胰腺感染性坏死患者临床资料。其中男3例，女2例；年龄39～67岁，中位年龄47岁；2例行开腹内引流术，3例行胃镜下穿刺置管内引流术。术后均出现胰腺感染性坏死的典型临床及影像学表现。所有患者均签署知情同意书，符合医学伦理学规定。患者行CT引导下经皮穿刺置管引流术（PCD），经皮肾镜腹膜后入路胰周坏死组织清除术，术后冲洗引流。

4例接受1次肾镜治疗，1例接受2次肾镜治疗，均治愈出院。术后住院时间15（7～32）d，无围手术期死亡及术后并发症发生。

肾镜治疗手术创伤小，疗效好，可作为WON被误认为胰腺假性囊肿行内引流术后导致感染的最佳补救性治疗手段。

To investigate the application value of nephroscopic treatment for the infection after internal drainage in severe acute pancreatitis patients complicated with walled-off necrosis (WON).

Clinical data of 5 WON patients who were misdiagnosed with pancreatic pseudocyst and developed infected pancreatic necrosis after undergoing internal drainage in Chinese PLA General Hospital between January 2010 and February 2016 were retrospectively analyzed. Among the 5 patients, 3 were males and 2 were females, with the age ranging from 39 to 67 years old and the median of 47 years old. Two cases underwent open internal drainage and 3 underwent gastroscopic percutaneous catheter internal drainage. Typical clinical and imaging manifestations of infected pancreatic necrosis were all observed postoperatively. The informed consents of all patients were obtained and the local ethical committee approval was receive. Patients initially underwent CT guided percutaneous catheter drainage (PCD), and then underwent percutaneous nephroscopic debridement of peripancreatic necrotic tissues by retroperitoneal approach and postoperative lavage and drainage.

Four cases recovered and discharged from hospital after once nephroscopic treatment, and 1 after twice nephroscopic treatment. The median postoperative length of stay was 15(7-32) d. No perioperative death or postoperative complications were observed.

Nephroscopic treatment is a good remedial therapy with advantages of minimal invasion and good efficacy for infection after internal drainage in patients with WON who are misdiagnosed with pancreatic pseudocyst.