胆源性胰腺炎的手术时机探讨

THE DISCUSSION OF OPERATION TIMING FOR ACUTE GALLSTONE PANCREATITIS

目的 为提高急性胆源性胰腺炎（ＡＧＰ）的治疗效果，探索ＡＧＰ早期手术适应证及最佳手术时机。方法 通过回顾分析１４３例ＡＧＰ病人并将其分为梗阻性胆源性胰腺炎（ＯＡＧＰ）及非梗阻性胆源性胰腺炎（ＮＯＡＧＰ）２组。结果 ＯＡＧＰ组４９例作了较早期手术，４４例治愈，ＮＯＡＧＰ组９４例均先行非手术治疗，２周至３个月后再行延期胆道手术，结果死亡１ 例，余均治愈。结论 必须正确把握ＡＧＰ的手术时机，并认为：具有梗阻因素的ＡＧＰ在严密监测下积极的非手术治疗２４～７２ 小时后，如梗阻不能缓解，则宜手术解除梗阻；而非梗阻性的ＡＧＰ则先行非手术治疗控制病情，尔后行延期的胆道手术。

Objective To study the therapeutic effects and explore the early surgical indication and optimun operation timing in patients with acute gallstone pancreatitis(AGP).Methods 143 cases of AGP were retrospectively analysed and were devided into two groups:AGP with biliary obstruction(OAGP)and with no biliary obstruction(NOAGP).Results all 49 cases in OAGP were treated by earlier biliary operations and 44 cases were cured;all 94 NOAGP cases by non surgical procedure.Conclusion The results indicated that it was important to choose the proper operation timing and it suggested that earlier operation should be performed for those OAGP after positive medical therapy in 24-72 hours under intensively monitoring,while early nonoperative methods and selective operation should be accepted for those NOAGP cases.