急性胆源性胰腺炎的临床类型与治疗方案的选择

Clinical type and the choice of the treatment for acute biliary pancreatitis

目的探讨急性胆源性胰腺炎的临床分型与治疗方案的选择。方法对1997年7月至2002年7月收治的248例急性胆源性胰腺炎进行回顾性分析。结果①轻症非梗阻型3个组皆无死亡,唯非手术组有3次出现脏器功能不全。②轻症梗阻型早期手术组出现2次脏器功能不全,非手术出现1例死亡,4次脏器功能不全或衰竭。③重症非梗阻型早期手术组2例死亡,出现8次脏器功能不全或衰竭,延期手术组无死亡,出现6次脏器功能不全或衰竭,非手术组死亡5例,出现11次脏器功能不全或衰竭。④重症梗阻型早期手术组3例死亡,出现6次脏器功能不全或衰竭,延期手术组1例死亡,出现4次脏器功能不全或衰竭,非手术组1例死亡,出现4次脏器功能不全或衰竭。结论①轻症非梗阻型以非手术为主。②轻症梗阻型可先行保守治疗,同时密切观察梗阻情况,如梗阻未解除,可待应激期过后手术解除梗阻,如梗阻解除可继续保守治疗。③重度非梗阻型以非手术治疗为主,并按胰腺坏死是否并发感染决定其是否手术。④重症梗阻型可先行积极的短期的保守治疗(24～72小时),如病情无好转,梗阻未解除,则早期手术治疗,手术宜简化,减少创伤,或行EST解除梗阻,如梗阻能够解除,则按重症非梗阻型处理。

Objective To evaluate the clinical type and the choice of the tr ea tment for acute biliary pancreatitis. Methods 248 cases from July 1997 to July 2 002 were retrospectively analysed. Result ①There was no death in three groups o f non-obstructive mild type, only 3 organ dysfunctions.②There were 2 organ dys functions in the early surgery group and one death and 4 organ dysfunctions in t he non-surgery group. ③There were 2 deaths non-obstructive severe type, 8 org an dysfunctions, no death and occurred 6 organ dysfunctions in the delayed surge ry, 5 deaths and 11 organ dysfunctions in the non-surgery group. ④3 deaths in obstructive, 6 organ dysfunction in the early surgery group, one death and 4 org an dysfunctions in the delalyed surgery group, one death and 4 organ dysfunction s in the non-surgery group. Conclusion ①Non-obstructive mild type was treated mainly in non-surgery. ②Obstructive mild type were treated conservatively fir st as well as obstruction was watched closely. If obstruction didn′t be resolve d, it should be resolved by operation after stressful period. If obstruction was resolved, the conservative treatment was to continue. ③Non-obstructive severe type was treated mainly by non-surgery and the timing of surgery depends on wh ether necrosis complicated with infection. ④To obstructive severe type. A short period of especially conservative treatment should be done, operation should be simplified and and reduce damage, or EST was performed to resolve obstruction. If obstruction can be resolved, the project of treatment was similar to non-obs tructive severe type.