胆源性胰腺炎的外科治疗

Surgical treatment of Gallstone Pancreatitis

目的 探讨胆源性胰腺炎 (GP)的外科治疗原则。方法 回顾分析本院 1991年 1月至2 0 0 0年 1月收治的GP12 0例 ,其中轻型 95例 ,重型 2 5例。结果 (1)GP早期手术组 (入院 4 8小时内 )与延期手术组 (入院 4 8小时后 )其住院日并无差别 ,但早期手术组胆总管探查率 (10 0 % )、多脏器功能障碍综合征 (MODS)发生率 (40 % )、胰腺感染率 (2 8% )及死亡率 (2 0 % )均明显高于延期手术组 ,分别为P <0 .0 5、P <0 .0 1、P <0 .0 1、P <0 .0 1。 (2 )重型GP的MODS发生率和胰腺感染率分别为 4 8%和 32 % ,死亡原因与MODS及胰腺感染呈明显的正相关。结论 轻型GP经综合治疗愈后 ,应在同一住院期间手术去除胆道病因以防复发。重型GP综合治疗的同时 ,根据“个体化”原则选取适当的手术时机和手术方式。防治MODS及胰腺感染是降低GP死亡率的关键。

Objective To evaluate the principles of surgery treatment for gallstone pancreatitis (GP). Methods 120 cases of GP, including 95 cases of mild and 25 cases of severe, were retrospectively from Jan. 1991 to Jan. 2000. Results In mild gallstone pancreatitis, there was significant difference in hospital delay between early operation group (less than 48 h after admission) and delayed operation group (more than 48 h after admission). But in the early operation group the common bile duct exploratory rate (100%), incidence of MODS (40%), pancreatic infectious rate (28%) and mortality (20%) were obviously higher than in the delayed operation group. In severe gallstone pancreatitis, the incidence of MODS and pancreatic infectious rate was 48 % and 32% respectively. The primary factors of death in severe GP patients were pancreatic infection and MODS. Conclusions Delayed surgical treatment for mild GP and delayed and selective surgery for severe GP were recommended. Prevention and treatment of MODS and pancreatic infection was the key to reduce the mortality of GP.