胃癌术后早期并发重症急性胰腺炎的原因及其诊治

Etiology and management of early postoperative severe acute pancreatitis following radical gastrectomy

目的探讨胃癌术后早期并发重症急性胰腺炎(SAP)的原因及其临床诊治。方法收集2000年11月～2003年10月该院外科收治的并发于胃癌术后早期的SAP病例作回顾性分析。结果697例胃癌手术患者中有9例在术后早期发生SAP,发生率为1.29%,其中姑息性手术后无SAP发生;D1-2根治术后发生SAP4例(0.80%);全胃切除术后发生SAP3例(5.66%);全胃联合脏器切除后发生SAP2例(13.33%),全胃切除与全胃联合脏器切除手术后SPA发生率比较无统计学差异(P>0.05),但与D1-2术式后SPA发生率比较有显著性差异(P<0.01)。9例SAP中有7例在发病初期行手术治疗,其中1例死亡;未手术的2例均死亡。结论胃癌术后早期SAP的发生与手术切除和淋巴结清扫范围密切相关。由于该并发症临床症状不典型,病情进展快,故预后差。CT是早期诊断本病的可靠手段,而积极的清创引流手术则是有效的治疗方法。

Objective To investigate the etiology and management of early postoperative severe acute pancreatitis（SAP） following radi- cal gastrectomy. Methods The cases of SAP following radical gastrectomy hospitalized in our hospital from November 2000 to October 2003 were retrospectively analyzed. Results Among all the 697 patients with operations for gastric cancer, early postoperative SAP happened in 9 （1.29%）. No SAP took place after palliative surgery, 4（ 0.80% ）after D1-2 radical operation, 3 （5.66%）after total gastrectomy and 2 （13.33%）after total gastrectomy combining viscerectomy （TGCV）. There were significant differences between D1-2 radical operation and total gastrectomy in incidence rate of postoperative SAP（ P 〈 0.01 ） , while no such difference was found between TGCV and total gastrectomy （P 〉 0. 05）. Among the 9 patients with SAP, 7 were managed with early explorative operation and thorough drainage, among whom one was dead. While either of the other two with conservative treatment survived. Conclusion There is a close relationship between early postoperative SAP and the scope of operation and lymphadenectomy for gastric cancer. The prognosis of early postoperative SAP is poor because of the rapid development and atypical clinical symptoms. CT is a reliable way for early diagnosis, and debridement and drainage is an efficient way of treatment.