重症急性胆源性胰腺炎手术时机和方法的选择

Operation time and methods of severe acute biliary pancreatitis.

目的探讨重症急性胆源性胰腺炎(SABP)的手术时机和手术方法。方法对36例SABP患者的手术时机、手术方式、治愈率、复发率及病死率等进行回顾性分析。结果早期手术治疗10例中治愈6例 ,自动出院和死亡各2例 ,平均住院时间48.5天。早期行非手术治疗24例 ,其中中转手术治疗达4例 ,死亡2例 ,复发1例 ,平均住院时间62天 ;延期手术治疗19例 ,全部治愈 ,平均住院时间43天。另2例重症Ⅱ型非手术治疗早期死亡(入院2～3天内)。结论SABP的手术时机是影响手术病死率与抢救成功率的重要因素 ,应采用延期手术与个体化治疗相结合的原则 ,即该及时手术的要果断 ,能保守的予延期手术。术式选择应以简单有效、充分引流、清除病灶、去除病因为基本原则。ERCP

Objective To investigate the operation time and methods of severe acute biliary pancreatitis(SABP). Methods The operation time, operation methods, and the cure rate, relapse rate, mortality rate were analyzed in 36 patients with the SABP. Results Among the patients with early stage operation(n=10), 6 patients were cured, 4 patients were dead or selfdischarge. The average charge time is 48.5 days. Conservative therapy was performed on the other 26 patients and 2 patients were dead in the early 3 days, 4 with the emergency operation half were dead, 19 patients had the postpone operation which all cured. The average charge time is 62 days. Conclusion The operation time is one of the most important factors of the treatment of SABP. It affects the cure rate and mortality rate. We advise persist in individual treatment, but also recommend to postpone operation as well on principle. The operation must be simple, efficient and pertinent. The plan of ERCP+ES and biliary duct of travesed nose are recommended.