外科治疗急性坏死性胰腺炎—14年经验总结(英文)

Surgical treatment for acute necrotizing pancreatitis:14 years’ experience in a single Chinese Center

目的：分析急性坏死性胰腺炎（ANP）术后死亡的原因，探讨ANP的手术指征和合理的手术方式。方法：将手术治疗ANP112例分成死亡组和存活组，对有关预后的指标进行对比和统计学分析。结果：两组病人的平均年龄、性别比例和起病时间比较接近，早期休克、成人呼吸窘迫综合症（ARDS）、发热、血象和高血糖的发生率在两组间没有明是差异（P均〉0．05）。与死亡有关的主要因素有：①胰腺的坏死程度；②手术方式不正确；③手术指征不妥。结论：轻、中度ANP应该首先试行非手术治疗48～72h。术前早期休克和ARDS应该及时纠正。术中应该充分游离肿胀的胰腺，有利于术后充分引流。建议行十二指肠造口术。

Objective ：To Investigate the reasonable approach and surgical incllcatlon for acute necrotizing panoreatitis（ANP）by analyzing the factors that affecting the mortality of ANP. Methods：One hundred and twelve patients with ANP were retrospectively divided Into two groups-the dead and the survivors. Some parameters were analyzed statistically to reveal what＇ s the reason for death, Results：The average age,sex ratio and onset of lilness were slmllar Detween two groups. And the ratlo of early shock, early adult resplratory cllstress syndrome （ARDS）, high temperature, leukooytosis and high blood glucose between two groups were also simllar between two groups（P〉0. 05, respectively）. The Important factors that affecting the mortality were： ① severity of pancreatic necrosis, ② Improper surgical approach, ③ Incorrect surgical Indication. Conclusion ：The patiets with mlid or moderate ANP should mainly recelve conservative treatment for 48-22 hours. The early shook and ARDS should be redressed before surgical Intervention. If the operation is unavoidable,the swelling pancreas should be dlssected fully, which will provide sufficient drainage after operation,and duodenostomy should be performed during operation.