重症急性胰腺炎手术治疗31例临床分析

Surgical Treatment of Severe Acute Pancreatitis:A Clinical Analysis of 31 Cases

目的探讨重症急性胰腺炎(SAP)患者的手术时机与手术指征。方法对31例SAP患者手术治疗的临床资料(采用坏死胰腺组织清除术+坏死腔引流术17例、胰腺被膜切开减压+腹腔引流术4例、胆管切开取石+腹腔引流术4例、胆总管切开T管引流术3例、单纯腹腔灌洗术及胰腺假性囊肿引流术3例)进行回顾性分析。结果 31例患者治愈23例(74.2%),死亡7例(23.0%,ARDS 2例、MOF 2例、感染性休克1例、败血症1例及应激性溃疡并消化道出血1例),术后转院治疗1例。结论 SAP患者手术指征、手术时机以及手术方式应针对患者具体情况采取相应的治疗措施;手术治疗仍然需要不断的经验总结和探索。

Objective To investigate the timing and indications for surgical treatment of severe acute pancreatitis（SAP）. Methods Clinical data of 31 SAP patients who underwent surgical treatment were retrospectively analyzed,including 17 patients who underwent necrotic pancreatic tissue dissection and necrotic cavity drainage,4 patients who underwent pancreatic capsule decompression and abdominal drainage,4 patients who underwent choledocholithotomy and abdominal drainage,3 patients who underwent T-tube drainage after common bile duct exploration, and 3 patients who underwent peritoneal lavage and pancreatic pseudocyst drainage. Results Among the 31 patients,23 （74.2%） were cured,7 （23.0%） died,and 1 was transferred to another hospital.The causes of death included acute res-piratory distress syndrome （n=2）, multiple organ failure （n=2）, septic shock （n=1）, septicaemia （n=1）, and stress ulcer complicated by alimentary tract hemorrhage （n=1）. Conclusion Surgical indications, timing and pocedures should aim at specific conditions of SAP patients,and the surgical treatment still needs to be explored and the experience needs to be summarized constantly.