急性胆源性胰腺炎的诊治体会

Experience with diagnosis and treatment of acute biliogenic pancreatitis

目的 总结急性胆源性胰腺炎的诊治体会,以改进诊治方法。方法 对110例胆源性胰腺炎的临床资料进行回顾性分析。结果 110例中83例确是胆源性胰腺炎,其中入院时胆道仍有梗阻者（梗阻型）34例,梗阻已解除者（非梗阻型）49例。其余27例不是胆源性胰腺炎,20例只是胆源性一过性胰高压,7例乃一般胰腺炎,发病与胆道无关。结论 诊断胆源性胰腺炎要有根据,临床上不可凡遇胆道有结石,血或（和）尿淀粉酶升高就诊断为胆源性胰腺炎。要根据治疗前胆道有无梗阻对胆源性胰腺炎分型论治:梗阻型应尽早引流解除胆道梗阻,非梗阻型直积极保守治疗,病情缓解后在同一住院期内手术。胆源性一过性胰高压和胰腺炎要按胆道或胰腺病情处理,不可一概按胆源性胰腺炎治疗。

Objective To summarize our experience in diagnosis and treatment of biliogenic pancreatitis and improve the therapeutic modality. Methods 110 cases of pancreatitis were analyzed retrospectively. Results Of the 110 patients, 83 were as confirmed as having biliogenic pancreatitis, of whom, 34 had calculous bile duct obstruction on admission, and 49 had relieved biliary obstruction. Biliogenic pancreatitis was excluded from the remaining 27 patients, including 7 with pancreatitis of other causes and 20 with transient pancreatic hypertension. Conclusions Diagnosis of biliogenic pancreatitis should not depend simply on the elevation of serum amylase and presence of gallstone. Biliogenic pancreatitis may be classified as obstructive and non obstructive. For the obstructive type of biliogenic pancreatitis, drainage should be done as early as posible, and for the non obstructive type, conservative treatment is preferable. Transient pancreatic hypertension and pancreatitis of other causes should be treated according to the pancreatic and biliary situations.