重症急性胆源性胰腺炎早期非手术治疗的临床探讨

Clinical Experience of Nonsurgical Treatment for Severe Acute Biliary Pancreatitis in Early Stage

目的 探讨重症急性胆源性胰腺炎(severeacutebiliarypancreatitis, SABP)早期非手术治疗的方法与效果。 方法 回顾性分析本院1997年1月至2003年12月收治的114例早期非手术治疗的SABP患者的死亡率、并发症发生率和中转手术的情况。 结果 114例中治愈103例,死亡11例,治愈率90. 35%。治疗过程中出现各类并发症42例( 53例次) , 其中多器官功能不全或衰竭9例次(7. 89% ), 坏死组织继发感染4例次(3. 51% ), 胰腺假性囊肿17例次(14. 91% ), 急性肺损伤21例次(18. 42% ), 胰性脑病2例次(1. 75% )。患者预后与APACHE-Ⅱ评分有关。2周内中转手术6例(5. 26% ),包括胰腺坏死组织继发感染4例和不能控制的胆道感染2例。梗阻性和非梗阻性SABP在死亡率和胰腺坏死组织继发感染发生率上相似(P>0. 05)。 结论 SABP早期(2周内)经积极非手术治疗可获得满意疗效,梗阻性SABP当存在不能控制的胆道感染时需早期行胆道手术。中转手术的指征为胰腺坏死组织继发感染、不能控制的胆道感染及治疗期间出现其他外科并发症。

Objective To investigate the conservative treatment for severe acute biliary pancreatitis(SABP) in the early stage. Methods 114 cases of SABP were admitted in our department from January 1997 to December 2003. The mortality, morbidity and indication of surgical intervention were retrospectively analysed. Results Of the 114 patients with SABP, 103 patients(90.35%) were cured and the rest 11 patients (9.65%) died. Various complications were found in 42 patients during the course of management, which included multiple organ dysfunction syndrome/multiple organ failure (9), pancreatic infection (4) and pancreatic pseudocyst(17), acute lung injury(21) and pancreatogenic encephalopathy(2). Prognosis associated with APACHE-Ⅱ scale. Six patients(5.26%) were transferred to surgical intervention because of pancreatic infection and uncontrollable biliary infection within two weeks. There was no significant difference of mortality and incidence of pancreatic necrotic tissue infection between obstructive and nonobstructive SABP. Conclusions The outcome of aggressively conservative treatment for SABP in early stage is applauding. Prompt operation should be employed when posed with infected necrosis, progressive biliary infection, and certain surgical complication. Patients with uncontrollable biliary infection may benefit from emergency biliary ductal exploration. In patients with infected necrosis, surgical treatment should be considered without delay.