急性坏死性胰腺炎的临床表现和治疗

Diagnosis and treatment of acute necrosis pancreatitis

目的 :总结急性坏死性胰腺炎 (ANP)的临床表现 ,探讨对 ANP的诊断和治疗方法。方法 :共 46例 ,经腹腔穿刺抽出血性腹水后 ,立即行急诊剖腹手术 ,从发病到手术平均时间约 (2 9.36± 3.42 )小时 ,手术后采用抑制胰腺分泌及抗感染等综合治疗。结果 :39例存活 ,7例死亡。死亡患者的特点 :有明显的诱因、既往身体健康、入院时体征不明显 ,但病情迅速恶化 ;胰腺坏死严重 ,无恢复希望、手术前后多器官功能衰竭迅速发生、手术后腹腔内组织继续大量坏死。结论 :详细采集病史、CT检查 ,有助于本病的诊断 ,积极使用扩血管药物 ,改善胰腺血液循环 ,及时行坏死胰腺全切除可能较为合适。

Objective:To summarize the clinical manifestations of acute necrosis pancreatitis(SNP) and discuss its diagnosis and treatment. Methods:46 patients with SAP were operated on after they were stabbed hemorrhage ascites from their cavities. Their pancreases were not handled by operator and the pancreatic capsules were kept integrate during operations. Results:Of 46 cases, 39 survived, 7 died. The characteristics of the seven cases were: all of them had obvious predisposing causes、unexpected onset、healthy、history, obscure physical signs, but quick deterioration. During operation, their pancreases showed serious necrosis and could not be repaired. Multiple organ failure occurred quickly after operations. They made very difficult management.Conclusion:The treatment and diagnosis of ANP should include careful collection of history, the improvement of the pacreatic blood circulation and total pancreatectomy.