非手术治疗重症急性胰腺炎92例

Nonoperative Treatment of Severe Acute Pancratitis (A Report of 92 cases)

为了探讨重症急性胰腺炎的诊断和选择适当的治疗方法，对９２例重症急性胰腺炎（ＳＡＰ）的临床资料进行了分析。结果发现：Ｒａｎｓｏｎ指标及ＣＴ诊断与临床经过大致相符。两个象限以上的腹膜炎，血性腹水和腹水淀粉酶≥２５６温氏单位同时存在，即可明确胰腺实质有出血坏死，可确诊为ＳＡＰ；结合ＣＴ检查可进一步了解胰腺的病理改变，更有利于临床治疗；ＳＡＰ极易并发成人呼吸窘迫综合症（ＡＰＤＳ），高渗晶胶混合液可防治ＡＲＤＳ，并可迅速纠正休克；在非手术治疗过程中，仍有部分病人需要中转手术。全组治愈７１例（７７．１７％），死亡２１例（２２．８２％）。认为：ＳＡＰ的诊断应以临床表现为主，大部分患者都可经非手术治愈。

To explore the diagnosis and treatment methods for acute sever pancreatitis (SAP), we investigated the clinical data of 92 cases of SAP who underwent nonoperative treatment. We found that the Ranson's criteria and CT diagnosis could roughly predict the clinical course. Hemorrhage and necrosis of pancreas parenchyma could be determined and the diagnosis of SAP could be made, if the patient had peritonitis over two quadrent and bloody ascites with elevated serum amylase (≥256u); While conbination with CT Scan, the pathologic changes of pancrease could be defined clearly which would be beneficial to the treatment. Adult respiratory distress syndrome (ARDS) was a common complication of SAP. The hypertonic mixed crystal and colloid solution was effective to prevent and treat ARDS, and to be rapid in correction of shock. Some cases needed operation in the course of nonoperation treatment. Of all the cases, 71 patients (71.7%) were cured, 21 patients (22.9%) died. We think that the diagnosis of SAP should lie on the clinical presentation, and that most of the patients can be treated nonoperatively.