20例急性胆源性重症胰腺炎手术治疗体会并文献复习

Surgery for severe acute biliary pancreatitis: clinical analysis of 20 cases and literature review

目的探讨急性胆源性重症胰腺炎的手术时机。方法对该科2009年4月～2011年6月收治的胆石症引起的急性重症胆源性胰腺炎20例手术效果进行回顾性分析。结果除2例在48 h内出现梗阻性化脓性胆管炎,1例在48 h内出现黄疸进行性加重行急诊手术外,其余17例行延期手术,急诊手术有1例死于多脏器功能衰竭,延期手术无死亡及并发症病例。结论急性胆源性重症胰腺炎应首先行非手术治疗,待度过急性期,一般在起病3周后在同一住院期间延期手术较为安全,对于非手术治疗过程中胆道梗阻进行性加重或并发其它局部或全身并发症者,则及时中转手术。

Objective To investigate the timing and indications of surgical management in the patients with severe acute biliary pancreatitis.Methods The operation effect of 20 cases of severe acute biliary pancreatitis in our department from April of 2009 to June of 2011 was retrospectively analysed.Results Of the 2 cases of suppurative cholangitis and 1 case aggravated choleplania receiving early emergency operation,one died of multiple organ failure.There was no occurrence of postoperative complications or death in the other 17 cases receiving delayed surgery.Conclusion Severe acute biliary pancreatitis should be treated during its acute stage.The delayed surgery can be done after 3 weeks of admission.Early emergency operation should be done unless acute obstructive suppurative cholangitis and other local or systemic complications occur.