重型非胆道梗阻性急性胆石性胰腺炎的外科处理

Surgical treatment of severe acute gallstone pancreatitis without biliary obstruction

目的探讨重型非胆道梗阻性急性胆石性胰腺炎的外科处理要点。方法分析47例重型非胆道梗阻性急性胆石性胰腺炎病人的临床资料。结果(1)1999年8月以前,13例采用早期手术,4例死于早期多脏器功能衰竭,病死率为30.8%;存活者平均住院时间为51.5d、平均医疗费用为9.53万元。(2)1999年8月以后,22例采用早期区域动脉灌注治疗,1例死于后期感染并发症,病死率为4.5%;存活者平均住院时间为31.3d,平均医疗费用为4.64万元。(3)12例采用传统保守治疗,4例病情较重者3例死于早期多脏器功能障碍;其余8例病情较轻者无并发症治愈。结论(1)在急性反应期内,作好复苏治疗的同时,推荐应用区域动脉灌注治疗重型非梗阻性胆石性胰腺炎;(2)重视临床类型的鉴别和转化,发现胆道梗阻及时手术治疗;(3)病变后期出现胰腺局部并发症需要适时的择期手术;(4)非手术治疗成功者应适时手术解除胆石病变以防止胰腺炎复发。

Objective To study the surgical treatment outlines of non obstructive severe gallstone pancreatitis （NOSGP）. Methods The clinical data of 47 patients with NOSGP treated in our hospital were retrospectively analyzed. Results 1） Thirteen patients were operated on in early stage before August 1999 and 4 of them died of multiple organ failure in the early stage （mortality = 30.8%）. Mean duration of hospitalization and mean fee-for-service of the survival was 51.5 d and RMB 95 300 yuan, respectively. 2） Twenty-two patients were treated by regional intra-arterial infusion in the early stage after August 1999. One of them died of infectious complications in late stage and the mortality was 4. 5%. Mean duration of hospitalization and mean fee-for-service of the survival was 31.3 d and RMB 46 400 yuan, respectively. 3） Twelve patients were treated by traditional conservative methods. Three of the 4 patients whose illness state was worse died of multiple organ failure in the early stage. The other 8 patients were cured. Conclusions 1） In acute response stage, the resuscitative therapy is important. Meanwhile, the regional intra-arterial infusion should be applied in nonobstructive severe acute gallstone pancreatitis. 2） We should pay attention to judging the clinical classification of gallstone pancreatitis and its transformation. If biliary obstruction exists, the operation should be done immediately. 3） If pancreatic local complications exist in the late stage, the operation should be carried out in optimal time phase. 4） To prevent recurrence of pancreatitis in those cases cured by non-operative approaches, operation should be performed at a proper time.