急性胰腺炎的手术时机与手术方法

Timing of Operation and Surgical Methods for Acute Pancreatitis

目的:探讨急性胰腺炎的手术时机、手术方法。方法:回顾性分析笔者所在医院收治的236例急性胰腺炎行手术治疗病例,其中重症急性胰腺炎有59例。手术方法有单纯胰腺周围引流术、胰腺被膜切开减压加胰腺周围引流术、胰腺坏死病灶切除清创术、脓肿引流术、囊肿引流或切除术、胆囊切除术、胆总管探查引流术加胆囊切除术、胰腺周围引流术加胆囊切除术加胆总管探查引流术等。结果:236例手术者治愈226例,治愈率95.8%(226/236),其中SAP手术的治愈率为83.1%(49/59);10例因病情恶化自动出院死亡,死亡率为4.2%(10/236)。结论:对于急性胰腺炎治疗应在病程的各个阶段采取"个体化"的防治措施。对合并胆石者,应根据胰腺炎不同的病理类型,积极选择适当的手术时机。胰腺假性囊肿多在急性期后行引流术。胰腺周围血管破裂可行经导管出血动脉栓塞术或破裂血管缝扎止血术。对重症急性胰腺炎合并腹腔间室隔综合症或感染者,应及时行开腹减压、胰腺周围感染坏死组织清创术及引流术。

Objective：To investigate the timing of operation and surgical methods for acute pancreatitis （ AP ） .Method：236 patients with AP who had undergone Surgical treatments were retrospectively reviewed, including 59 cases of sevfre acute panereatitis （ SAP ） . Surgical treatments were performed as follows：open surgical neerosectomy and debridement, open packing and drainage, simple cholecystectomy, common bile duct drainage, etc.Result：226 patients who had undergone surgical treatments were cured, with the cure rate of 95.8% （ 226/236 ）, in which 49 cases of SAP were cured, with the cure rate of 83.1% （ 49/59 ）, while 10 patients （ 4.2% ） died or discharged because of severe complications.Conclusion：Different treatments should be performed indlvidually.The patients with gallstone-associated pancreatitis should undertake biliary tract operations at the time of the index admission.Those with the complication of pancreatic pseudocyst should be performed catheter drainage after the acute episode of pancreatitis. For those patients with the complication of bleeding, however, emergency arteriography should be performed to delineate the site of bleeding, and to embolize it if possible.If the bleeding cannot be stopped by embolization, emergency surgery should be performed to suture ligate the bleeding vessel. For those patients with SAP who are accompanied by infection or abdominal compartment syndrome （ ACS ）, open surgical necrosectomy and debridement, open packing and wide sump drainage should be performed as soon as possible.