重症急性胰腺炎168例临床分析

Clinical Analysis of Severe Acute Pancreatitis in 168 Cases

目的通过对重症急性胰腺炎治疗的分析,总结临床治疗经验和方法。方法回顾性分析北京市顺义区医院近5年(2006年10月-2011年10月)收治的168例重症急性胰腺炎患者的治疗过程、方法及结果。结果全组168例患者,其中经内科综合治疗151例,治愈142例(94.0%),死亡9例;手术治疗17例(包括内镜逆行胰胆管造影+乳头括约肌切开、胆囊切除术+胆总管探查、ERCP术后腹腔镜下胆囊切除术及胰腺坏死组织清除引流术),治愈14例(82.4%),死亡3例。全组患者合并消化道出血患者12例、急性肾功能衰竭(acute renal failure,ARF)患者20例、急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者12例、肝功能异常患者98例、多脏器功能障碍综合征(multiple organ dysfunction syndrome,MODS)患者18例、术后出现胰腺假性巨大囊肿者3例、胰瘘3例。结论重症急性胰腺炎的治疗以非手术治疗方法为主,必要时可分别采取开腹手术、内镜手术、腹腔镜手术等综合治疗方法。

Objective To summarize the clinical experience and methods by analyzing treatment of SAP（severe acute pan- creatitis）. Methods Retrospective analysis of 168 cases with severe acute pancreatitis treatment in our hospital in past 5 years （from Oct. 2006 to Oct. 2011 ）. Results In all 168 cases, 142 cases were cured by medical treatment while 9 patients died, 14 cases were cured by surgery（ including ERCP ＋ EST, chnlecystectomy and common bile duct exploration, or laparoscopic cholecys- tectomy after ERCP or pancreatic necrosis debridement treatment） while 3 patients died. Of all patients, 12 cases with gastrointes- tinal bleeding,20 cases with acute renal failure, ARDS 12 cases,liver function abnormal 98 cases, MODS 18 cases, 3 cases with pancreatic pseudocyst huge cyst,3 cases with pancreatic leakage. Conclusion Treatment of severe acute pancreatitis was mainly with non-surgical treatment,if necessary, take traditional surgery, endoscopic surgery and laparoscopic surgery treatment.