重症急性胰腺炎坏死组织清除的指征与方法探讨

Discussion on the indications and procedures for removing pancreatic and surrounding necrotic tissue in severe acute pancreatitis.

目的 探讨重症急性胰腺炎 (SAP)的手术指征、方法及注意事项。方法 回顾性分析 2 0 0 0～ 2 0 0 3年收治并经手术处理的 13例SAP病人的临床资料。结果 本组男 7例 ,女 6例。年龄平均 4 4 4 6岁。全组都进行了手术干预 :1次手术 1例 ,余 12例经过 2～ 4次手术。 8例出现相关并发症并得到及时处理。 12例获救 ,1例高龄者死于MOF。结论 (1)无特定指征早期 (发病 12h内 )不推荐手术。 (2 )发病后 3～ 4周是最佳手术时机。(3)手术清除坏死组织应轻柔 ,注意止血。

Objective To explore the indications, procedures and cautions for the pancreatic and surrounding necrotic tissue removal in severe acute pancreatitis(SAP). Methods A retrospective study was conducted to analyze operational methods of 13 patients with SAP in our hospital from 2000 to 2003 and to investigate the feasible surgical procedures and indications by consulting related documents. Results Among the 13 patients, 7 males and 6 females, mean age was 44.46 years, and all of them were performed operations: one patient had only one operation, others have at least 2 to 4 operations.Eight patients had related complication after operation, and 12 patients recovered,while the one elderly patient died of MOF. Conclusion (1)The operation treatment for the patients without specific indication in early 12 hours of ill process shouldn't be performed.(2)Three to four weeks of illness process are optimal time for operation.(3)The operation should be careful for removing necrotic tissue and hemostasis should be paid attention to.