急性重症胰腺炎65例临床分析

Clinical analysis of severe acute pancreatitis:on 65 cases report

目的总结急性重症胰腺炎(SAP)的诊治经验。方法回顾性分析SAP患者65例的治疗转归并相关文献复习。结果 65例SAP患者中治愈51例,死亡14例,病死率为21.5%。65例SAP患者中行急诊手术11例,其中胆源性胰腺炎行内镜下十二指肠乳头肌切开术(EST)或胆总管切开取石+T管引流术7例,术后痊愈5例,死亡2例;其他行胰腺被膜切开减压、引流及空肠造瘘术4例,术后痊愈2例,死亡2例。其余54例采用常规禁饮食、胃肠减压、抗休克等治疗,合并冠心病死于心力衰竭3例,死于呼吸衰竭4例,17例SAP患者非手术治疗后期出现胰腺坏死感染,行胰腺坏死组织清除术,其中3例SAP患者因出现败血症,引发多器官功能衰竭死亡。结论 SAP早期治疗中液体复苏及器官功能保护是重点,而把握手术适应证及手术时机和选择合适的手术方式是提高疗效的关键。

Objective To summarize the experience in the diagnosis and treatment of severe acute pancreatitis （SAP）. Methods Retrospectively analyzed the treatment outcome of 65 patients with SAP and review the relevant literature. Results 65 cases patients with SAP,51 cases were cured, 14 cases were death, the fatality rate was 21.5%. 11 cases of pa- tients with emergency operation,7 cases of patients were treated by endoscopic sphincterotomy or choledncholithotomy and ＋ T tube drainage. After surgery,5 cases were cured,2 cases were death. 4 cases of patients were treated by Pancreatic envelope in- cision decompression, drainage and Jejunostomy, Mter surgery, 2 cases were cured, 2 cases were death. 54 patients with SPA were given conventional fasting, gastrointestinal decompression, anti-shock, inhibition of pancreatic secretion and prevention of infection. 3 patients of SPA combined with coronary heart disease died of heart failure ,4 patients of SPA combined with coro- nary heart disease died of respiratory failure. 17 cases of patients with SPA treated by nonoperative treatment were infection of pancreatic necrosis. 3 cases of patients with SPA died of multiple organ failure due to the occurrence of sepsis. Conclusion Fluid resuscitation and organ function protection were importment in early treatment of SAP, Grasp the surgical indications and timing of surgery, and select the appropriate surgical approach is the key to improve the efficacy.