胃癌根治术后急性胰腺炎的发病特点和防治

ACUTE PANCREATITIS FOLLOWING RADICAL GASTRECTOMY FOR CARCINOMA OF THE STOMACH: ITS FEATURES, PREVENTION AND TREATMENT

①目的 探讨胃癌根治术后急性胰腺炎的发病特点和防治方法。②方法 对 10 16例胃癌根治术后发生急性胰腺炎 4例病人的临床资料进行分析。③结果 术后急性胰腺炎的发生率为 0 .39%。发病时间为术后11h～ 4d。表现为术后切口和腹部疼痛渐剧 ,腹痛位置模糊 ,肠蠕动恢复障碍 ,以及烦躁、出冷汗、心动过速、低血压。实验室检查 :WBC(1.2～ 1.6 )× 10 9/L ,中性粒细胞 0 .81～ 0 .91。非手术治疗 3例 ,2例治愈 ,1例死亡 ;手术治疗1例 ,痊愈。④结论 术后切口和腹痛较剧、出冷汗、心动过速、肠功能恢复障碍是胃癌根治术后急性胰腺炎的临床特点。术中尽可能减少对胰腺的袭扰和损伤 ,置腹腔引流 ,高危病人术后慎用哌替啶镇痛 ,适当应用H2 受体拮抗剂。

Objective\ To investigate the clinical features and management of postoperative acute pancreatitis following radical surgery for gastric cancer. \ Methods\ A review of 1016 radical gastrectomies for carcinoma of the stomach was made, in which, four patients were found to have acute pancreatitis. The clinical data of these four cases were analyzed.\ Results\ The mobidity of acute panceratitis was 0.39%(4/1 016). They occurred at from 11 hours to four days postoperatively. The manifestations were: pain in incision and increasing abdominal pain with obscure sites, failure of bowel movement, and dysphoria, tachycardia as well as hypotension. White blood cell count above (1.2-1.6)×10 9/L, neutrophil being 0.81-0.91. Three were treated in conservative way, one died and two cured; one underwent surgery and recovered uneventfully.\ Conclusion\ Severe postoperative incision and abdominal pain, cold sweat, tachycardia and disorder of bowel function are features of acute pancreatitis following radical surgery for gastric carcinoma. Avoidance of rude manipulation and injury of pancreas during operation, abdominal drainage, careful postoperative application of pethidine for high risk patients, proper use of H 2 recepter antagonist and somatostain are conducive to prevention of this complication.