急性出血坏死性胰腺炎非手术治疗的后期处理

A STUDY ON THE MANAGEMENTS OF ACUTE HEMORRHAGIC NECROTIZING PANCREATITIS (AHNP) IN THE LATER STAGE AFTER THE NONOPERATIVE TREATMENT

我院1965年至1995年81例急性出血坏死性胰炎在早期积极的非手术治疗后,63例需要后期进一步处理的问题,包括胆结石31例,坏死性肿块17例,假性囊肿15例。非手术治疗恢复比较顺利的10例,在发病后一个月左右时用腹腔镜完成胆囊切除加经胆囊管胆总管造影,胆总管内有结石的仅(10％);17例坏死性肿块仅3例因肿块出血感染而需中转手术治疗;17例复发,其中5例原因不明,经ERCP证实十二指肠乳头旁憩室及十二指肠乳头癌各1命名;12例假性囊肿自行吸收(80％)。

Many patients with acute hemorrhagic necrotizing pancreatitis (AHNP) can be cured by the active conservative managements, but some problems such as gallstone, AHNP recurrence, necrotic mass and pseudocysts occurred in about one half of the patients which need to be further treated. The present study showed that the incidence of the choledocholith was 10% (1/10) in biliary pancreatitis and the chole-cystectomy plus choledochography through the cystic duct can be performed by the laparoscopy one month after the episode of AHNP if the recover process was smooth; the para - ampulla tumor should be excluded for some patients whose reasons of relapse were unclear; the operation was not necessary to be performed for the patients with noncomplicated necrotic mass, a temporary high temperature was also not a absolute indication of operation; 80%(12/15) of the pseudocysts formed after the conservative treatment can be absorbed, which was different from that formed after other reasons.