胆源性急性胰腺炎早期非手术治疗探讨

Explore in Nonsurgical Treatment of Acute Biliogenic Pancreatitis

目的：探讨胆源性急性胰腺炎（BAP）早期非手术治疗的可行性。方法：2002年3月～2007年3月收治的急性胰腺炎（AP）142例，其中胆源性急性胰腺炎114例，根据有无胆道梗阻及急性胰腺炎轻重程度分为4类：轻症非梗阻型、轻症梗阻型、重症非梗阻型、重症梗阻型，对不同类型临床治疗结果回顾性分析和总结。结果：轻症非梗阻型40例，在发病3周内经非手术治疗均痊愈；轻症梗阻型35例，在发病3周内经非手术治疗均痊愈。重症非梗阻型20例，行非手术治疗17例，死亡2例，中转手术3例，死亡1例；重症梗阻型19例，非手术治疗15例，死亡2例；中转手术治疗4例，死亡1例。结论：急性胰腺炎（AP）早期（3周内），一般均可非手术治疗，待胰腺炎症水肿消退，病情稳定后及时手术治疗。

Objective： To study the feasibility of nonsurgical treatment of acute biliogenic pancreatitis in the early stage. Methods： From March 2002 to March 2007, 142 cases of acute pancreatitis（AP） were studied. Among them, 114 cases were diagnosed as biliogenic acute pancreatitis, and divided into four types： acute mild unobstructive biliogenic pancreatitis, mild onstructive one, severe unobstructive one and severe obstructive one. Results： Of them, 40 cases of acute mild unobstructive biliogenic pancreatitis were cures by nonsurgical treatment within the first three weeks of disease; 35 cases of acute mild onstructive biliogenic pancreatitis were cured, 20 cases of acute severe unobstructive biliogenic pancreatitis, 17 adopted conservervative treatment and 2 died, including 3 cases receiving emergent operation and 1 died. ; of 19 cases of acute severe obstructive biliogenic pancreatitis, 15 cases accepted nonsurgical treatment and 2 died, 4 were performed with operation and 1 died. Conclusion： Conservative treatment can be adopted for the early phase of BAP（within 3 weeks）, operation should be taken until pancreatic edema is repressed and patient＇s condition is stable.