重症胆源性胰腺炎手术时机的探讨

Study of Operation Timing for Severe Gallstone Pancreatitis

目的为提高重症胆源性胰腺炎 (SGP)的治疗效果 ,探讨SGP早期手术适应证和最佳手术时间。方法采用统计学方法回顾性分析 5 2例SGP的手术时机与并发症及死亡情况。结果早期手术 (住院 48h内 ) 2 2例和延期手术 (病情稳定 6～ 8周后 )3 0例的并发症的发生率分别为 3 1.8%和 3 .3 % (P<0 .0 2 5 ) ,病死率分别为 13 .6%和 0 (P <0 .0 5 ) ;胆总管探查率分别为 90 .9%和 5 6.7% (P <0 .0 1)。结论SGP的手术时机应采用延期与个体化相结合的处理原则 ,即首先应积极系统的非手术治疗 ,在临床症状控制 6～ 8周后延期手术 ,能够降低SGP的病死率、并发症和胆总管探查率。在出现以胆道梗阻为主 。

ObjectiveTo explore the early surgical indication and optimal operation timing in patients with severe gallstone pancreatitis (SGP) for the purpose of improving its therapeutic effects. Methods A retrospective analysis on optimal operation timing , complications and mortality of 52 SGP patients admitted from Jan.,1995 to May 2000 was done by statistical methods.. Results Twenty-two cases were operated at early stage (within 48 hr after admission); 30 cases at delayed stage (6～8 weeks following stabilization of disease). The complication rate in these 2 groups were 31.8% and 3.3% (P<0.025), mortality 13.6% and 0% and choledochus exploratory rate 90.9% and 56.7%, respectively. ConclusionsThe results suggest that earlier operation should be performed when obstruction of bile duct is dominant, SGP is exacerbated or SGP is complicated with diffuse peritonitis. In general, non-operation systematic therapy may be preferably considered , then delayed operation after clinical symptoms controlled for 6～8 wks can reduce the mortality of SGP.