重症急性胰腺炎64例治疗体会

Treatment of severe acute pancreatitis: An experience of 64 cases

目的:探讨重症急性胰腺炎的治疗方法。方法:对比分析64例重症急性胰腺炎手术治疗组(n=31)与非手术治疗组(n=33)的并发症发生率、病死率,以及对手术治疗重症急性胰腺炎的手术时机、手术方式等作回顾性分析。结果:非手术治疗组的主要并发症(ARDS、肾功能不全)的发生率和病死率均明显低于手术治疗组(P<0.05);48 h内的早期手术病死率(9.5%)亦明显低于48 h后手术的病死率(50.0%)(P<0.05)。术式以坏死组织清除术疗效较好。结论:重症急性胰腺炎早期应采用非手术治疗为主。手术治疗并不能降低重症急性胰腺炎的并发症和病死率。必需手术者在病后48 h内手术效果好,术式以坏死组织清除术,术后加用腹腔灌洗、引流较合适。

Objective： To evaluate the therapeutic methods of patients with severe acute pancrcatitis（SAP）. Methods： A comparative study was carried out in 64 patients with SAP by allocating them to surgical（ n= 31 ） or nonsurgical treatment group （ n = 33）. Factors as complication incidence, case-fatality rate, timing of operation and procedures were taken into consideration retrospectively. Results ： Serious complications （ARDS, renal inadequacy, ）and case-fatality rate in nonsurgical group were significantly lower than that in surgical group （P 〈 0.05）. In surgical therapy group, patients treated with operation within 48 hours in their earlier period, the fatality rate（9.5 % ） was evidently lower than that（50.0 % ） over 48 hours （ P 〈 0.05）. It was necessary to consider the removal of necrotic tissues in surgery. Conclusion ： Expectant treatment should be considered as the best choice in treating SAP patients in their earlier period, for surgical treatment can not reduce complication incidence and fatality in such cases. Timing of operation should be favorable within 48 hours after the onset if surgery is necessary. However, it is wise to remove necrotic tissues and employ peritoneal lavage and drainage after operation.