急性胆源性胰腺炎的临床治疗探讨

Clinical Treatment of Acute Biliary Pancreatitis

目的：探讨提高急性胆源性胰腺炎（acute biliary pancreatitis,ABP）疗效的治疗方法.方法：本组共48例ABP患者,其中胆道梗阻性11例、非梗阻性37例.对梗阻性ABP患者采取早期急诊手术治疗,手术方式为胆囊切除、胆总管切开取石、T管引流,胰腺包膜切开引流、胰腺坏死组织和感染灶清除;对非梗阻性ABP患者早期采取非手术治疗.结果：非梗阻性ABP 37例,其中34例经非手术治疗痊愈;3例出现体温升高、病情恶化者急诊手术,2例痊愈,1例死于多器官功能衰竭.11例梗阻性ABP行急诊手术治疗,发生并发症5例,均治愈.结论：急性胆源性胰腺炎的治疗应遵循个体化原则,对伴有胆道梗阻者早期宜行急诊手术,其它类型的急性胆源性胰腺炎早期宜非手术治疗.选择正确的治疗方法,把握恰当的手术时机,可提高治愈率,降低病死率.

Objective：To investigate the treatment for raising efficacy of acute biliary pancreatitis （ABP）. Methods ： Among 48 cases of ABP patients （ 11 cases of biliary obstruction and 37 cases of non - obstructive）, the early emergency surgical treatment was performed for ABP patients with obstructive. Surgical procedure including cholecysteetomy, common bile duct stones, T- tube drainage, pancreatic capsule incision and drainage, removal of pancreatic necrotic tissue and loci. Non - surgical treatment was performed for the patients with non - obstructive in the early stage. Results ： Of 37 ABP cases of non - obstructive, 34 cases with non-surgical treatment were cured. 3 cases with fever and disease progression were performed emergency surgery, 2 cases were cured, and 1 case died of multiple organ failure. 11 ABP cases of obstructive were taken emergency surgery, 5 cases with complications were cured. Conclusions ： The treatment of acute biliary pancreatitis should follow the individual method. Emergency surgery should be performed early for those associated with biliary obstruction. Other types of acute biliary pancreatitis should adopt non - surgical treatment. It can improve the cure rate and reduce mortality of ABP by choosing the right treatment and taking the appropriate timing of surgery.