重症急性胰腺炎201例

Severe acute pancreatitis: a retrospective analysis of 201 cases

目的:探讨重症急性胰腺炎(severeacutepancreatitis,SAP)的病因、临床表现、严重度评估、诊断和治疗措施.方法:回顾分析1993-01/2004-01我院收治SAP201例结果:胆源性胰腺炎59.2%,其余依次为特发性胰腺炎、手术后胰腺炎和酒精性胰腺炎.临床症状以上腹部疼痛为主,伴或不伴腰背部放射痛.多数伴有恶心、呕吐等消化道症状.动态增强CT扫描是明确诊断、严重度分级及发现并发症的准确的影像学方法.APACHEⅡ(24h),APACHEⅡ(48h),Ranson和CT评分分别为7.21±4.71,6.03±4.57,2.24±1.43和4.30±1.36(P<0.05).发生各类并发症157例.1993/1998年行非手术治疗17例,死亡0例:手术治疗39例,死亡4例.1999/2004年非手术治疗141例,死亡7例:转手术治疗4例,死亡2例.结论:SAP病因以胆源性为主,临床症状缺乏特异性,影像学检查有助于早期诊断及严重度分级.早期治疗应采用中西医结合的非手术疗法,严格掌握手术指征,避免早期手术治疗,合理使用内镜技术,均能取得理想的治疗效果.

AIM: To investigate the etiological factors, clinical manifestations, diagnosis and treatment of severe acute pancreatitis (SAP). METHODS: A total of 201 patients with severe acute pancreatitis admitted in Changhai Hospital from January 1993 to January 2004 were retrospectively analyzed. RESULTS: Of all the 201 SAP patients, 59.2% were associated with biliary tract disease, and the rest were related to idiopathic, postoperative, and alcoholic factors. Epigastric pain was the predominant clinical manifestation, with or without radiating lumbar and back pain. Digestive manifestations such as nausea and vomiting appeared in most patients. Contrast-enhanced dynamic computed tomography was a precise imaging technique for defining diagnosis and severity grading as well as for complication detection.The values of APACHE Ⅱ (24 h), APACHE Ⅱ (48 h), Ranson and CT score were 7.21±4.71,6.03±4.57, 2.24±1.43 and 4.30±1.36,respectively (P<0.05). Complications occurred in 157 patients. From 1993 to 1998, 17 patients received nonoperative treatment(integrated traditional and western medicine),and there was no mortality. 39 patients received operative treatment with 4 deaths. From 1999 to 2004,141 patients received nonoperative treatment with 7 deaths, and 4 received operative treatment with 2 deaths. CONCLUSION: SAP is mainly induced by biliary disease with no specific clinical manifestations. The imaging techniques are beneficial for the early diagnosis and severity grading. Nonsurgical treatment integrating traditional and western medicine should be applied for early therapy. Strictly handling the indications for surgery, avoiding early surgery and rationally using endoscopic technique may help to gain the satisfactory therapeutic efficacy.