基于中医外科学原理谈重症急性胰腺炎之诊治策略

Discussion on diagnosis and treatment strategy of severe acute pancreatitis based on traditional Chinese medicine surgery

重症急性胰腺炎(SAP)是重症医学科常见疾病之一,属于“外科病”范畴,本病在中医古代文献中无对应之病名诊断。基于中医外科学原理,以“胰痈”作为SAP的中医病名,可准确概括本病的病位、病性、治疗、转归,中医外科学“消托补”三法可用于SAP之全程治疗,胰痈早期热毒壅滞,可予大柴胡汤合大承气汤消散热毒;胰痈中期坏腐成脓期,可予大柴胡汤合理中汤托脓促进坏死局限;胰痈恢复期局限包裹、穿刺引流,可辨证选用补气养血中药促进组织修复,从而缩短病程。此外,基于中医外科学对于痈疽“脓熟”与否的判断经验,可用于指导胰痈微创干预时机的选择,中药的托补治疗可促进SAP病灶局限包裹“成脓”,为微创手术干预创造时机。

Severe acute pancreatitis(SAP)is one of the common diseases in Intensive Care Unit(ICU),which belongs to the category of‘surgical disease’.There is no corresponding diagnosis of SAP in ancient Chinese medicine literature.Based on the principle of Traditional Chinese medicine(TCM)surgery,‘pancreatic carbuncle’is taken as the TCM disease name of SAP,which can accurately summarize the disease location,pathologic characteristics,treatment and prognosis.The three methods of TCM surgery,‘xiao tuo bu’,can be used for the whole treatment of SAP.In the middle stage of pancreatic carbuncle,it can be given Dachaihu Decoction to promote the limited necrosis.In convalescence of pancreatic carbuncle,limited wrapping and puncture drainage can be used to promote tissue repair based on differentiation of symptoms and symptoms,thus shortening the course of disease.In addition,based on the judgment experience of TCM surgery on whether the ulcer is abscessed or not,it can be used to guide the selection of minimally invasive intervention time for pancreatic abscess.TCM complementary treatment can promote the‘abscess formation’of SAP lesions,creating an opportunity for minimally invasive surgical intervention.