儿童重症胰腺炎治疗的商榷

SEVERE ACUTE PANCREATITIS IN CHILDREN

探讨在努力确诊前提下合理治疗儿童重症胰腺炎（SAP）。方法总结4例儿童SAP处理体合，复习近年国内报道38例的经验教训。结果迄今大多数病例未能确诊、拟为其他急腹症急诊手术。术式多样分散，而疗效尚佳（仅4例死亡）；提示手术针对性不强，其必要性有待商榷。结论应辅以BUS、CT、腹穿等尽力弄清诊断。与成人一样，本病应首选非手术治疗。手术指征应严格掌握，合并感染时必须手术，术式宜简易，时机一般宜延迟。

Objective To establish correct diagnosis and then to properly treat the children with severe acute pancreatitis(SAP). Methods Summing up the authors' experince of managing the 4 cases with SAP and reviewing the reports conceyned with38 cases in this country in recent years. Results As yet most of the children with SAP could not be accurately diagnosed preoperatively,and early operation had been performed for other acute abdominal diseases. Though the kinds of opertion were various and diverse, yet the curative effects were quite satisfactory(only 4 deaths),suggesting the surgery seemed not strongly directed againstthe lesions. The necessity of operation managing would need more discussion. Conclusion Try to make a precise diagnosis by various measures such as BUS,CT,abdominal paracentesis,etc. As in adult patients,the treatment for the children with SAP shouldfirst be nonoperative. SAP could not simply be cured operatively,nor the operation stopped the developement of the inflammatorylesions of this disease,and some serious postoperative complications might be caused. The surgery for SAP should accurately be indicated,being absolutely necessary when complicated with infection. The operation should be simpler and effective. Generally itstiming should be delayed.