对重症胰腺炎早期手术的评价

EVALUATION OF EARLY TURGICAL INTERVENTION FOR SEVERE ACUTE PANCREATITIS

本文报道早期手术治疗重症胰腺炎32例。手术内容主要为胰包膜切开,游离胰腺,引流胰床和大小腹腔,以及三造瘘。少数患者做了坏死组织挖除。术后通过导管灌洗小腹腔和胰床。术后有4例因循环衰竭或低血容量性休克,死于术后3日内,有16例于术后发生坏死组织感染,其中8例死于感染所引起的各种并发症和器官功能衰竭。全组共死亡12例,死亡率为37.5%,作者认为早期手术不能阻止病变的发展。手术时由于坏死组织与生活组织无明显分界,难以做到坏死组织清除。早期引流胰腺,易导致坏死组织感染,产生多种并发症和造成很高的死亡率。因此,作者认为对重症胰腺炎应在大力支持治疗下争取延期或择期手术。

The present article reports the results of early surgical intervention for thirty twopatients with severe acute panceatitis.Operations included incision of pancreatic capsule,division of pancrea,drainage of pancreatic bed,and triple ostomy.Debridement ofnecretic tissue was underwent in a few patients.After operation,pancreatic bed wasirrigated through large-bore lavage catheters.Six petients died of circulatory system (?)ailure or hypovolemic shock within three days after operation.16 patients developedinfection of necrotic tissue after operation.Eight patients died of varous complicationsand multiorgan failure caused by sepsis.In this series,12 patients died.The mortalitywas 37.5% The authers think that the early operation can't stop the progress of disease.Because the demarcation between necrotic and viable tisseu is not clear in early stageof disease,adequate debridement of necrotic tissee seems impossible.Early pancreaticdraiiage may cause infection of necrotic tissue,develop various complications and highmortality.Therefore,the authers suggest an intensive conservative approach and delaythe surgical intervention for patient with severe acute pancreatitis.