重症急性胰腺炎外科处理的再认识

Re-evaluation of Surgical Management in Treatment of Severe Acute Pancreatitis

目的:研究“个体化”治疗和延期手术方法对重症急性胰腺炎的治疗效果.方法:临床分析“个体化”治疗和延期手术方法对35例重症急性胰腺炎的治疗效果.结果:20例重症急性胰腺炎经非手术治疗获得成功,11例经延期手术治愈,3例死于急性期ARDS和肾衰,1例死于真菌败血症.结论:“个体化治疗”和延期手术方法能较好地提高重症急性胰腺炎治愈率,降低死亡率.胰腺坏死可能或已伴感染的病例也可通过非手术治疗获得成功,关键是密切动态观察其感染是否能逐步得到控制.强调非手术治疗方案必须是综合性的.

Objective: To study the effects of 'Individualized Management' and delayed operation in the treatment of severe acute pancreatitis. Methods: Thirty-five cases of severe acute pancreatitis treated under the principle of 'Individualized Management' and delayed operation were retrospectively analyzed. Results: Twenty cases of the series were cured by nonoperative managment, 11 cases cured by delayed operation, while 3 cases died of ARDS and acute kidney failure, and 1 died of fungus septicemia. Conclusions: The cure rate of severe acute pancreatitis had been increased by adopting the principle of 'individualized Management' and delayed operation, and its mortality decreased. It is our belief that pancreatic necrosis with no serious infection can also be cured by nonoperative management. It is of utmost importance to observe closely whether the infection could be successfully controlled during the non-operative management. The comprehensive nature of the nonoperative treatment is to be emphasized.