手术治疗重症急性胰腺炎的预后影响因素分析

Influencing preoperative factors on surgery outcome of severe acute pancreatitis

目的探讨手术治疗重症急性胰腺炎(SAP)的效果及影响因素。方法将141例重症急性胰腺炎患者根据病因分为胆源性SAP组和非胆源性SAP组,比较两组早期和延期手术存活率,以及生存患者与死亡患者年龄、Ranson's评分、Binder评分、手术距发病平均天数。结果胆源性SAP组早期手术存活率为71.4%,延期手术存活率为70.6%,两组差异无统计学意义(P>0.05)。非胆源性SAP组患者早期手术存活率为77.8%,延期手术存活率为81.1%,两组差异无统计学意义(P>0.05)。胆源性SAP组中死亡患者与存活患者年龄、手术距发病时间无统计学差异,死亡患者术前Ranson's评分、Binder评分偏高;非胆源性SAP组中死亡患者年龄、Ranson's评分、术前Binder评分偏高,手术距发病时间较短。结论手术早晚不是决定外科治疗重症急性胰腺炎的主要因素,而Binder评分可以作为一项评价重症急性胰腺炎手术治疗预后的良好指标。

Objective To explore the key factors which affect the effect of surgical treatment for patients with severe acute pancreatitis.Methods 141 cases were divided into the bliogenic pancreatitis group and the non-bliogenic pancreatitis group,and the survival rate,age,Ranson＇s score,Binder score and days between surgery and the onset of the disease were compared between the survivors and the dead.Results In the bliogenic pancreatitis group,the survival rate was 71.4% in those accepting early operation and 70.6% in those accepting delayed operation（P0.05）.In the non-bliogenic pancreatitis group,the survival rate was 77.8% in those accepting early operation and 81.1% in those accepting delayed operation（P0.05）.In the bliogenic pancreatitis group,the age and days between surgery and the onset of the disease had no statistical difference,but the Binder score and Ranson＇s score were higher in the dead compared to the survivors.In the non-bliogenic pancreatitis group,the age,Ranson＇s score and Binder score were higher,but the days between surgery and the onset of the disease was lower in the dead compared to the survivors.Conclusion Surgery time is not the key factor influencing surgical result,but Binder score can be used as a good index for assessing prognosis.