急性出血坏死性胰腺炎非手术治疗关键环节的研究——附83例分析

A STUDY ON THE MAIN PROCEDURES OF THE NONOPERATIVE TREATMENT FOR THE ACUTE HEMORRHAGIC NECROTIZING PANCREATITIS

从1970年1月至1996年4月共收治急性出血坏死性胰腺炎(AHNP)病人160例,1980年以前以简化手术为主,1980—1990年期间以经典手术为主,1990年以后以非手术治疗为主。非手术治疗组的各种并发症及死亡率均低于手术治疗组(p<0.05)。并发症ARDS、胰腺脓肿、腹腔出血可能和手术打击有关。因此非手术治疗值得提倡和推广。采用非手术治疗的关键环节:(一)诊断要十分明确;(二)早期(发病3—5日内)以纠正内环境紊乱及减轻胰外器官损害为主;(三)中期(发病2—4周内)以防治胰腺坏死组织继发感染为主;(四)后期(发病4周后)以处理胰腺坏死组织引起并发症为主。

160 patients with acute hemorrhagic necrotizing pancreatitis (AHNP) were treated in our hospital from January 1970 to April 1996 Most patients were treated with simple'operation before 1980, with conventional operative procesure from 1980 to .1990, and with nonoperative treatment after 1990. The complications and mortality in the nonoperative group were less than that in the operative group significantly (P'<0. 05). The high frequency rate of complications such as ARDS, pancreatic abscess, hemorrhage in abdominal cavity in the operative group might be relevant to the attack of operation . So the non-operative treatment should be recommended. The main procedures of nonoperative treatment include (1) to clarify the diagnosis of AHNP (2) to maintain the homeostasis and to reduce the damage of extrapan-creatic organ function at the early stage (3 - 5 days of the onset), (3)to prevent the infection of the necrotizing tissue of pancreas at the middle stage (2 - 4 weeks of onset), and (4)to treat the complications induced by the necrotizing tissue of pancreas at the later stage (after the fourth week).