急性坏死性胰腺炎病程分期探讨

A study on the staging or acute necrotizing pancreatitis

为探讨急性坏死性胰腺炎（ＡＮＰ）病程分期，作者回顾性总结了１６３例ＡＮＰ病例的资料，统计各种主要并发症的发生时间与发生率。本组病例中，手术治疗组病程约３个月左右，非手术治疗组约为１个月左右，ＡＮＰ病程可分为三个阶段：（１）急性反应期：约１０天左右，急性呼吸窘迫综合征、肾衰、休克、脑病的发病处于高峰阶段。（２）全身感染期：持续约２个月左右，以全身细菌感染及随后的深部霉菌感染或双重感染为临床特点。全身性细菌感染的发病高峰出现于病程１１～２０天，深部霉菌感染高峰出现于病程３１～４０天。（３）残余感染期：约在起病２～３个月后，临床表现为严重的全身营养不良，低热，手术后引流口长期不愈，造影证实有腹膜后残腔，往往合并有胰瘘或胃肠道瘘。本组病例的这些后期并发症发病高峰均出现于病程２个月以后。ＡＮＰ病程的三个阶段，是渐进性发展，相互之间没有明确界限。

In this study,a retrospective analysis was made on 163 cases hospitalized for acute necrotizing pancreatitis(ANP)to found the staging of the disease.The authors classified the consecutive course of the disease into three stages.Stage I(0-10 days of onset)is characterized by acute stress of the body including ARDS,kidney failure,shock,and encephalopathy.StageⅡ(days ic till two months)is a period of systemic infection which could be subdivided into stage of systemic bacteriological infection(days 11 to 20)and stage of deep fungous infection(days 20 after).Stage Ⅲ(beginning from two months after the onset)developed from stage n with major problem of residual infection. The clinical features include severe malnutrition,low fever,fistulas of the digestive tract etc.