重症胆源性胰腺炎手术时机的选择

Timing selection of operation for severe gallstone pancreatitis

探讨重症胆源性胰腺炎 (SGP)的最佳手术时机。方法 回顾性分析 67例SGP的手术时机与并发症及死亡情况。结果 SGPⅠ级早期手术和延期手术的并发症率分别为 54 54 %和 10 0 0 % (P <0 .0 5) ,病死率分别为 2 7 2 7%和 0 (P <0 .0 5)。SGPⅡ级早期手术与延期手术并发症率为 84 62 %和 4 1 67% (P <0 .0 5) ,病死率为 53 85%和2 5 0 0 % (P >0 .0 5)。结论 SGPⅠ级延期手术的并发症率和病死率较早期手术明显降低 ,应以延期手术治疗为主 ;SGPⅡ级延期手术的并发症率较早期手术明显下降 ,病死率无差异 。

Objective To evaluate the optimal timing of operation for severe gallstone pancreatitis(SGP). Methods The operation timing, morbidity and mortality of 67 cases of SGP were retrospectively analysed. Results In patients with grade Ⅰ of SGP, the morbidity and mortality of early surgery were 60.00% and 27.27%; and 10% and 0 in patients underwent delayed surgery respectively( P <0.05 and P <0.05). In patients with grade Ⅱ of SGP, the morbidity in patients with early operation(84.62%) compared with delayed operation(41.67%) was significant differente( P <0.05); but the mortality between patients with early operation(53.85%) and delayed operation(25.00%) was of no significant difference( P >0.05). Conclusions Comparing to delayed surgery, the early surgery for patients with grade Ⅰ of SGP has significantly higher morbidity and moratlity; for patients with grade Ⅰ of SGP, delayed surgery is preferable. For patients with grade Ⅱ of SGP, the morbidity in early surgery is higher significantly than that in delayed surgery, but the mortality shows no significant difference between early and delayed surgery, so the combination of delayed and selective surgery is suggested.