梗阻性重型胆石性胰腺炎的临床处理

Treatment of obstructive severe gallstone pancreatitis

目的探讨梗阻性重型胆石性胰腺炎的病变特点及处理原则。方法分析温州医学院第一附属医院1997年1月~2005年10月期间收治的10例梗阻性重型胆石性胰腺炎患者的临床资料。结果⑴6例患者存在胆总管结石,4例胆总管内未见结石;⑵4例出现Charcot三联征,1例出现Renyolds五联征;8例以右上腹痛为主,仅1例出现左上腹痛;6例呈胰头部局灶性坏死;2例见散在斑点状坏死;2例见弥漫性坏死灶。⑶外科收治的8例患者,全部采取早期手术治疗而获得治愈;内科收治的2例患者采取早期传统保守治疗,1例病情恶化第8天自动出院,1例病情好转遗留胆石病变出院。结论⑴胆管梗阻可导致胆石性胰腺炎,梗阻是原因,病因不除,疾病难以控制;⑵胆总管内未见结石的胆石性胰腺炎也可出现胆道梗阻,应引起临床重视;⑶梗阻性重型胆石性胰腺炎的病变特点：胆道症状突出,胰腺病变以局灶性胰头部坏死为主;⑷梗阻性重型胆石性胰腺炎应采取早期手术治疗,由外科收治较为合理。

Objective To study the clinical features and treatment roles of the obstructive severe gallstone pancreatitis.Methods The clinical data of 10 cases of obstructive severe gallstone pancreatitis in our hospital from Jan.1997 to Oct.2005 were analyzed.Results ①Six cases coexisted common bile duct bilestone,4 cases didn＇t coexist common bile duct bilestone.②4 cases complicated with Charcot triad,1 cases complicated with Reynolds pentalogy;8 cases showed right upper abdominal pain,only one case showed left upper abdominal pain;the pathological lesions of 6 cases were local necrosis of the head of pancreas,2 cases had scattering necrotizing spots.③8 cases hospitalized in our surgery department underwent operation in early stage,and all cases were cured.Nevertheless,traditional conservative treatments in early stage were taken in 2 cases hospitalized in medicine department,1 case died of worsening of gallstone pancreatitis,the other one case with bilestone left hospital.Conclusion ①Biliary obstruction may result in worsening of gallstone pancreatitis.②Biliary obstruction may exist in the cases without bilestone in common bile duct,this situation should be attached clinical importance to.③The clinical features： striking biliary symptom and local necrosis of head of pancreas.④Surgical operation must be performed in obstructive severe gallstone pancreatitis in early stage.It is reasonable that the patients may be attended by surgery department.