重症急性胰腺炎手术干预的时机与预后分析

The Timing of Surgical Treatment and Efficacy in Patients with Severe Acute Pancreatitis

目的探讨重症急性胰腺炎手术干预最佳时机。方法1980～2006年经治的168例重症急性胰腺炎,按治疗方法和手术时间不同分为A、B、C三个组,回顾性分析治疗效果。结果1980～1990为A组(57例),治疗简单,以早期(72h)手术为主,手术率80.7%,病死率66.7%;1991～1996年为B组(31例),以"个体化治疗方案"并适当延期(13～19d,平均16d)手术清创为主,手术率45.2%,病死率29%;1997～2006年为C组(80例),以综合治疗及延期(13～30d,平均21.5d)手术引流为主,手术率32.5%,病死率11.6%。结论重症急性胰腺炎的关健问题是坏死组织感染,深入认识其病生变化及疾病过程,合理安排综合治疗,正确选择手术时机,可提高疗效,改善预后。

Objective To investigate the timing of surgical management in patients with severe acute pancreatitis （SAP）. Methods the timing of operation and therapeutic efficacy were reviewed retrospectively in 168 cases of SAP from 1980 to 2006. Results the mortality and operability were 66.7% and 80.7% in 57 cases from 1980 to 1990, respectively; the mortality and operability were 29% and 45.2% in 31 cases from 1991 to 1996, respectively; the mortality and operability were 11.6%, 32.5% in 80 cases from 1997 to 2006, respectively. The mortality of patients received late operation and combined modality therapy was lower than those of patients received early operation. Conclusion the laparotomy timing is an important factor influencing mortality. The principles for management should be combined modality therapy and appropriate timing of operation.