重症急性胰腺炎的早期非手术治疗

Non-surgical treatment in the early stage of severe acute pancreatitis

目的探讨重症急性胰腺炎( SAP) 的早期治疗方法和合理方案.方法对1986 年6月～2004 年6 月收治的123例SAP患者按各个阶段治疗方法不同分为两组:A 组1986年6月～1992年6月以手术治疗为主53 例,B 组1992年7月～2004年6月以早期非手术治疗为主70例.结果手术组(A)病死率33.9% (18/53).并发症发生率:ARDS 28.3%(15/53)、休克16.9%(9/53),肾衰竭20.8%(11/53), 胰腺脓肿16.9%(9/53) , 心功能不全24.5%(13/53).早期非手术组(B)病死率分别为7.1% (5/70) .并发症发生率:ARDS14.3%(10/70),休克7.1%(5/70),肾衰竭7.1%(5/70), 胰腺脓肿2.8%(2/70) , 心功能不全4.2%(3/70).两组病死率及并发症率比较差异均有显著性(P<0.001).结论急性重症胰腺炎采用早期非手术治疗能有效降低病死率和并发症发生率.大多数重症急性胰腺炎可经非手术治愈.

Objective To explore a rational treatment program for the non-surgical treatment of severe acute pancreatitis (SAP) in the early stage. Methods The data of 123 cases of SAP treated from 1986 to 2004 were collected and divided into two groups according to admission time and treatment procedure. Group A:53 cases admitted from 1986 to 1992,treated mainly by operation. Group B :70 cases admitted from 1992 to 2004 ,treated mainly by non-surgical procedures. Results The mortality rate in group A and B was 33.9 %(18/53) and 7.1% (5/70),respectively,while the incidence rate of complications such as ARDS,shock,renal failure,pancreatic abscess,cardiac failure in group A was 28.3%(15/53),16.9%(9/53),20.8%(11/53),16.9%(9/53),24.5%(13/53),and in group B was 14.3%(10/70),7.1%(5/70),7.1%(5/70),2.8%(2/70), 4.2%(3/70),respectively. There was significant difference between the two groups (P<0.0 01 ). Conclusions Conservative treatment for the early stage of SAP can effectively decrease morbidity and mortality rates.The majority of cases of SAP can be cured with conservative treatment.