急性胆源性胰腺炎的治疗及手术时机的探讨

The treatment of acute biliary pancreatitis and the opportunity of operation,an experience report

目的：探讨急性胆源性胰腺炎的治疗方法及手术时机。方法回顾肇庆市第一人民医院普外科2012年6月至2015年6月收治198例 ABP 患者的临床资料。结果198例中,8例经保守治疗病愈；138例轻症ABP患者在一次住院期间处理胆道结石；28例重症 ABP 患者经保守治疗病情好转,3~4周后处理胆道结石；22例重症梗阻型ABP经守保治疗无好转,急诊内镜或介入行胆道内引流,1~3月后再住院处理胆道结石；2例急性梗阻性胆管炎并重症胰腺炎患者行急诊开腹手术行胆道引流及胰腺周围引流,1例经治疗38 d 病情好转出院,1例因严重的腹腔及肺部感染死亡。结论 ABP 的治疗应遵行保守治疗为主,延期手术的原则,根据有无胆道梗阻,胆管炎和胰腺炎的严重程度,决定外科治疗的方法及手术时机。

Objective To investigate the treatment of acute biliary pancreatitis and the opportunity of operation. Methods The clinical data of 198 ABP patients admitted to the department of general surgery, the First People’s Hospital of Zhaoqing city from June 2012 to June 2015 were reviewed. Results A total of 198 cases were included in the study and subjected to surgery. Of them, Eight patients recovered after conservative treatment; 138 cases of mild ABP cases were performed surgery for bile duct stones at the first admission; Twenty-eight cases of severe ABP patients received expectant treatment for 3-4 weeks before surgical procedure at the first admission; Twenty-two cases of severe obstructive ABP were treated by emergent endoscopic intervention for biliary drainage due to failed expectant treatment and surgical procedure at two admissions in 1-3 months; Two cases of obstructive cholangitis complicated with acute severe cholangitis were subjected to surgery and one cured, another was dead of severe abdominal and pulmonary infection. The patients were treated with open surgery, endoscopic intervention or laparoscopic operation according to the condition of the patients. Conclusion Based on the AP classification, biliary obstruction, and severity of pancreatitis cholangitis, to decided the surgical the timing and approach.