胆源性重症急性胰腺炎的早期手术治疗(附28例分析)

THE EARLY OPERATION FOR BILIARY SEVERE ACUTE PANCREATITIS:AN ANALYSIS OF 28 CASES

目的 探讨胆源性重症急性胰腺炎 (BSAP)早期手术的可行性、指征和术式。方法 回顾性分析本院经早期手术或延期手术治疗的 2 8例BSAP的临床资料。结果 早期手术 (15例 ) :死亡 2例 (13.3% ) ;术后重要并发症 6例 (40 .0 % ) ;再手术 3例 (2 0 .0 % ) ;平均手术时间 90min。延期手术 (13例 ) :死亡 2例 (15 .4% ) ;术后重要并发症 7例 (5 3.8% ) ;再手术 2例 (15 .4% ) ;平均手术时间 12 5min。结论 早期手术治疗BSAP是可行的。胆道梗阻性者一般应早期手术 ,无胆道梗阻性者手术指征仍应严格掌握 ;手术方式宜简单有效。

Objective To explore the feasibility,indications and operative procedures of the early operation for biliary severe acute pancreatitis(BSAP).Methods Clinical data of 28 patients with BSAP undergoing the early operation or the later operation in our hospital from January 1990 to December 2000 were analysed retrospectively.Results Among 15 cases undergoing the early operation,2 cases died(13.3%);6 cases (40.0%) had the important postoperative complications,including septicemia (n=3),ARDS(n=2) and renal failure (n=1);3 cases (20.0%) required re operation;and the mean operating time was 90 minuts.Among 13 cases undergoing the later operation,2 cases died(15.4%);7 cases(53.8%)had the important postoperative complications,inculding septcemia (n=2),ARDS(n=3) and renal failure(n=2);2 cases(15.4%) required re operationg;and the mean operating time was 125 minuts.Conclusion The early operation is feasible for BSAP.The early operation should be performed in BSAP with biliary obstruction,and should accurately be indicated in BSAP without biliary obstruction.The operative procedure should is simple and effective.