早期重症急性胰腺炎的手术与非手术治疗

Operative and Nonoperative Treatment in the Early Stage of Severe Acute Pancreatitis

为探讨无明确急诊手术指征的早期重症急性胰腺炎（ＳＡＰ）是否需要急诊手术治疗，将符合ＳＡＰ临床诊断标准的８５例早期ＳＡＰ患者随机分为非手术治疗组（４３例）和手术治疗组（４２例）。非手术组予以ＩＣＵ病房行器官功能监测，ＴＰＮ支持，大量联合应用广谱抗菌素，早期、短期使用肾上腺皮质激素、生长抑素、Ｈ２受体阻滞剂，适时使用利尿剂，适时恢复胃肠功能和胃肠内营养；手术组确诊后立即急诊手术，方法为广泛切除胰包膜、松解胰床，胰周置多管引流，术后常规小网膜囊灌洗，余处理与非手术治疗组完全相同。结果：非手术组３６例治愈，２例病死，５例病程迁延，治愈率８３．７％；手术组２７例治愈，６例病死，８例病程迁延，治愈率６４．３％；两组治愈率存在显著差异（Ｐ＜０．０５）。认为：早期重症急性胰腺炎以首先采用非手术治疗为佳。

In order to study whether the patients with the early stage of severe acute pancreatitis (SAP) who were without a definite operation indication should be performed an emergent operations, we divided 85 cases of early stage of SAP randomly into nonoperative (43 cases) and operative group (42 cases). The patients in nonoperative group were treated in ICU, with TPN, antibiotics, cortison, somatostatin, H2 retarder and diuretic patly; resuming the gastrointestinal function and nutrition patly. The patients in operative group were treated with an emergent operation including excising the capsule of pancreas, mobilizing the pancreas; put tubes for drainage, generally irrigatting the circumference of pancreas after the operation, other treatment as the same as in nonoperative group. The results showed as follows: In nonoperative group, 36 cases were cured (87.3%), 2 cases died and 5 cases deferred; in operative group, 27 cases were cured (64.3%), 6 cases died and 8 cases deferred. The difference of the cure rate in two groups was significant (P<0.05). So, the authors believe that for patients with the early stage of SAP, who are without a definite operation indication, the primary choice of treatment is nonoperative management.