重症急性胰腺炎手术时机的再探讨

Indications for operation in patients with severe acute pancreatitis

目的在改变早期手术为积极、有效、综合的非手术治疗的基础上,进一步探讨重症急性胰腺炎(SAP)的手术时机,以降低死亡率。方法对1990至1997年收治的143例 SAP 进行分析,所有病人均在 ICU 行监护及支持治疗。前期(1990～1994年),对胰腺感染(包括感染性胰腺坏死或液体积聚及胰腺脓肿)均急诊行引流及清创手术;近期(1995～1997年)采取延期手术的方法,将胰腺感染局限或胰腺脓肿作为手术指征。结果胰腺感染局限或脓肿者的手术次数及手术死亡率明显低于有感染性胰腺坏死或液体积聚立即手术者(P<0.05)。结论胰腺感染局限时手术治疗的效果优于胰腺感染未局限时手术,常一次手术成功。

Objective To study the indications of operation in patients with severe acute pancre- atitis(SAP).Methods Altogether 143 patients with SAP were treated in our ICU from 1990 to 1997. Indication for operation adopted from 1980 to 1994 was a positive Gram stain of culture of peripancreatic aspirates,including an infectious pancreatic necrosis or fluid accumulation and pancreatic abscess and it was pancreatic abscess or localized infection from 1995 to 1997.Results The number of operations and postoperative mortality rate of pancreatic abscess or localized infection were lower than those of infec- tious pancreatic necrosis or fluid accumulation(P<0.05).Conclusion The results sugggest compre- hensive management combined with late drainage of pancreatic abscess or localized infection and debride- ment of necrotic tissues are better treatments for SAP.