胆源性重症急性胰腺炎的治疗体会

TREATMENT OF GALLE SEVERE ACUTE PANCREATITIS(GSAP)

目的 探索胆源性重症急性胰腺炎 (GSAP)外科治疗新方法。方法 回顾 1990年 5月以来本院GSAP 6 2例治疗情况 ,其中非手术治疗 6例 ,手术治疗 5 6例。手术常规行腹腔积液清除、胆囊切除、胆道清理、胰包膜切开、引流术 ,其中 2 4例选择性附加胰及周围坏死组织清除 ,横贯式网膜腔引流和暂时性幽门锁闭 ,胆道、胃、空肠造口术 (即改良式Cogbill手术 )。结果 非手术组 :平均住院 2 6d ,死亡 3例 ,自动出院 2例 ,治愈 1例。手术组 :平均住院 36 .8d ,死亡 5例。行改良式Cogbill手术者 2 4例 ,无一例死亡。结论 本组GSAP的治疗方法选择手术疗法优于非手术疗法 ,手术方式选择 ,改良式Cogbill术式优于其他术式。

Objective To investigate a new surgical way for galle severe acute pancreatitis(GSAP).Methods The clinical data of 62 cases with GSAP were analysed from 1990 to now.Non surgical way was 6 cases and surgical way was 56 cases.General operated method was exploratory laparotomy,cholecystectomy,choledochotomy with exploration.Pancreatomy and drainage of abdomen.24 cases among 56 cases were operated by cleaning necrotic tissue of pancreas,traverse drainage of omental bursa,gastrostomy,jejunostomy,choledechotomy and temporary pylorus closed(modified Cogbill).Results In non operation group:all patients average were cured in 26 days.3 case was death and 2 case was unsuccessful.Only one case was cure.In operetion proup:all patientswere average cured 36.8 days.5 case was death by general surgical way and none was death by operated with modified Cogbill.Conclusion Result of operation group was markedly better than that of non operation group in treating GSAP.Result of modified Cogbill method was markedly better than of others surgical way.