重症急性胰腺炎的非手术治疗和早期手术治疗

Conservative Therapy Compared with Operations in Early Severe Acute Pancreatitis

目的 探讨非手术治疗和早期手术治疗重症急性胰腺炎病人的适应证及综合治疗原则。方法 回顾性总结 1986年 8月至 2 0 0 0年 12月收治的 82例SAP临床病例特征 .诊治情况及治疗结果。结果 本组病例 82例 ,非手术治疗 2 8例 ,治愈率 85 7% ,其并发症发生率 4 2 % ,主要是体克、急性肾功能衰竭、肺部感染等。死亡 4例 ,主要死于严重并发症 ;早期手术 5 4例 ,治愈 4 4例 ,治愈率 81 5 % ,其并发症发生率 4 4 5 % ,主要是急性肾功能衰竭、中毒性休克、ARDS及手术后严重并发症 ,主要死于术后严重并发症 ,总治愈率 82 9%。结论 对SAP病人的治疗要根据临床病例特征来决定非手术或早期手术治疗 ,在进行强有力的非手术治疗的同时 ,要严密观察病情变化及对治疗的反应情况 ,一旦发现有手术指征 ,要及早手术 ;对胆源性梗阻型SAP应行急症手术。

Objective To explore indications of the conservative therapy an early operative treatment for severe acute pancreatitis and researching comprehensive therapeutic rule.Methods Retrospective analyze the clinical feature and the result as making a diagnosis and giving treatment of 82 cases of SAP admitted from Aug.1986 to dec.2000.Results Among them,28 cases underwent conservative treatment,with the cure rate of 85.7%,54 cases underwent conservative treatment,with the cure rate of 81.5%,the total cure rate was 82.9%.Conclusions The conservative therapy or early operation of SAP is determined by the patients' clinica feature,while the supportive conservative therapy being on,we should carefully observe the changes of the patient's condition and the response to therapy,when once surgical indication being discovered,early operation should be performed ,the emergency surgery should be performed as soon as possible for the biliary obstruction of SAP.