用三种方法治疗重症急性胰腺炎所致并发症的分析

Clinical features and causes of complications of severe acute pancreatitis treated by three methods

目的 探讨重症急性胰腺炎采用不同方法治疗所发生并发症的临床特点、原因及防治对策。方法对我院外科1995年6月至2002年6月问收治的重症急性胰腺炎病人73例,按其主要治疗方法分为三组:早期手术组、早期传统保守组、早期区域动脉灌注组,对其各自所发生的并发症进行回顾性分析。结果①早期手术治疗组并发早期胰外脏器功能损害的发生率最高,与其他二组相比,有非常显著的统计学意义(P<0.001);②早期区域动脉灌注组并发胰腺假性囊肿的发生率最高,与其他二组相比,有统计学意义(P<0.05);③传统保守治疗组并发胰腺或胰周脓肿的发生率相对较高,但与其他组相比无统计学意义(P>0.05);④早期手术治疗组并发腹腔广泛感染或脓肿的发生率相对较高,但与其他组相比无统计学意义(P>0.05)。结论①强有力抑制胰酶激活、避免加重应激状态是早期胰外脏器功能损害发生率低的理由;②区域动脉灌注氟尿嘧啶、奥曲肽使胰腺分泌总量减少的同时,却使胰周局部渗出量增加是并发胰腺假性囊肿较高的病理学基础;③区域动脉灌注与手术治疗手段的有机结合是防治并发症的关键。

Objective To study the clinical features of, the causes of and how to prevent the complications of severe acute pancreatitis which were treated by three methods. Methods Seventy-three cases with severe acute pancreatitis which were treated from June 1995 to June 2002, were divided into three groups: operation group, conservative therapy group and regional artery infusion group. The clinical features of complications of each group were reviewed. Results ①The morbidity of epipancreas organs dysfunction in early stage in operation group was highest, the difference has very remarkable statistical significance (P<0. 001). ②The morbidity of pancreatic pseudo-cyst in regional artery infusion group was highest, the difference has statistical significance (P<0. 05). ③The morbidity of the pancreatic abscess or the abscess peripheral pancreas in conservative therapy group was rather higher than the others, but the difference had no statistical significance (P>0. 05). ④The morbidity of abdominal cavity infections or abscess in operation group was rather higher than the others, but the difference had no statistical significance (P>0. 05). Conclusions ①To inhibit pancreatic enzyme activation and to avoid aggravating excessive stimulation are the causes of low morbidity of epipancreas organ dysfunction in early stage.② The regional intra-arterial infusion with 5-Fluorouracil or Octreotide results in decreasing of pancreas secretion, but releasing of the acute fluid collection peripheral pancreas is pathological base of rather higher morbidity of pancreatic pseudocyst in late stage. ③To combine flexibly the regional artery infusion way and the operative way are the key for preventing and curing the complications.