急性坏死性胰腺炎外科治疗的十年回顾性分析

A Reappraisal of the Surgical Management of Acute Necrotizing Pancreatitis

目的:探讨急性坏死性胰腺炎的合理治疗方案、手术指征及手术方式.方法:回顾近10年来我科74例急性坏死性胰腺炎的外科治疗方式,对比经典术式、简化术式及非手术治疗三个不同治疗组的严重并发症发生率及治疗结果.结果:非手术组平均住院天数、ARDS和休克等严重并症的发生率均显著低于手术组;简化术式组的相应指标明显低于经典术式组.各组死亡率:手术组为25%(10/40),非手术组为2.9%(1/34);在手术组40例中,经典术式组为46.7%(7/15),简化术式组为12%(3/25),本组总的治愈率达85.1%.结论:ANP在未发生感染的早期行非手术治疗是可取的;如出现继发感染,可再中转手术;术式应简化,以适度的清除坏死组织和引流较为合理.

Objective: To evaluate the rational therapeutic regimen, operative indication and operative pattern in the treatment of acute necrotizing pancreatitis (ANP). Methods: Seventy-four cases of ANP were admitted to our department during the past ten years (from 1987 to 1997). The incidence of serious complications and curative effect were compared in 3 groups of different therapeutic strategy (classical operation, simplified operation and non-operative treatment). Results: The mean hospitalization days and the rate of serious complications such as ARDS and shock were significantly lower in the non-operative group than in the operative groups, the same criteria were lower in the group with simplified operation as compared to that undergoing classical operation. The mortality was 25%(10/40) in the operative group and 2.9%(l/34) in the non-operative group; it was 46.7^(7/15) in the group with classical operation and 12% (3/25) in the group with simplified operation. Conclusions: It is preferable to adopt the non-operative treatment in early ANP without infection, and of simplified operative procedures such as sequestrectomy and drainage should be undertaken when secondary infection occurs.