重症胰腺炎52例治疗体会

Clinical analysis of 62 cases of server acute pancreatitis

目的探讨重症胰腺炎(SAP)治疗方法。方法对1992—2003年收治52倒SAP患者的治疗方法、手术指征、手术方式进行回顾性分析。结果非手术治疗32例,Ⅰ级24例,Ⅱ级8例,Ⅰ级治愈22例,Ⅱ级治愈4例,非手术治愈26例,治愈率81%;手术治疗20例,Ⅰ级12例,Ⅱ级8例,Ⅰ级治愈8例,Ⅱ级治愈4例,手术治愈12例,治愈率60%。结论SAP经过积极的非手术治疗,大部分可以治愈,包括部分感染性胰坏死、胆源性SAP。炎症反应期尽量避免手术,争取延期手术或后期手术。但有些SAP必须手术才能去除病因,控制全身或局部感染,维持脏器功能。非手术治疗:发病初治疗重点是纠正内环境紊乱,减轻器官损害,阻止MODS的发展,阻止SIRS发展为全身性感染。手术治疗:手术原则是解除病因,清除胰腺、胰周坏死组织,有效的胰周减压对腹腔渗液和坏死组织建立通畅的引流。坏死组织不能强行清除,手术不能扩大。

Objective To investigate the therapeutic meathod of sever acuct pancreatitis(SAP) Methods analyze the clinical data of the 62 cases of severe acute pancreatitis from 1998 to 2006.Results amony 62 cases,30 were non-operated and 3 were died,32 were operated and 7 were died.The APACHE-Ⅱscores in surgical team were significantly higker than non-operated team.Conclusion The most severe acute pancreatitis can be cured by non-surgical treatment.Accurate time of operation,appropriate choice of surgical and individudal treat measures should improve the survival rate of severe acute pancreatitis.