急性重症胰腺炎中转手术时机探讨

目的 探讨非手术治疗急性重症胰腺炎中转手术的时机及指征。方法 回顾分析1991年5月～2003年12月我科收治的308例急性重症胰腺炎患者的并发症发生率、死亡率及中转手术情况。结果 治愈284例(92．2％)，死亡24例(7．8％)。治疗过程中109例出现并发症，其中胰腺坏死组织继发感染12例，胰腺假性囊肿52例，多器官功能损害或衰竭24例，单个器官功能损害27例。中转手术23例(7．5％)，其中行胰腺坏死组织清除12例，胰腺假性囊肿感染引流2例，腹腔引流5例，胰腺脓肿引流1例，因急性坏死性胆囊炎和急性化脓性胆囊炎行胆道手术各1例，穿孔修补 胰包膜减压术1例。结论 急性重症胰腺炎早期采取积极的非手术治疗可获得满意的效果；对在非手术治疗过程中出现胰腺感染、不能控制的胆道感染、病情无好转且进行性恶化者或有其他外科并发症者及时中转手术，可望提高急性重症胰腺炎的治愈率。

Appraisal of timely surgical intervention of severe acute pancreatitis

Objective To appraise the indication and the timely surgical intervention of severe acute pancreatitis (SAP). Methods Analysis of complication rate, mortality rate, and the indication of surgical intervention in 308 cases of SAP treated in our department from May.1991 to Dec.2003. Results 284 cases were cured (92.2%) and 24 cases died (7.8%). 109 patients developed various complications during the course of treatment. The complications included secondary infection of pancreatic necrosis(12 cases), pancreatic pseudocyst (52 cases),MODS or MOF (24 cases), single organ dysfunction (27 cases).23 patients (7.5%) with complications were transferred for surgical intervention. Among the 23 cases,12 underwent pancreatic necrosectomy, 2 drainage due to infected pancreatic pseudocyst, 5 abdominal cavity drainage, 1 drainage of pancreatic abscess, 2 cases with complicated by acute gangrenous cholecystitis and the other by acute suppurative cholecystitis treated by biliary operation and one perforation with repair plus pancreatic subcapsular decompression. Conclusion The efficacy of nonoperative treatment for patients with severe acute pancreatitis is satisfactory, but if further complicated by pancreatic infection with uncontrollable biliary infection, or progressive deterioration despite energetic treatment or with surgical complication, then timely surgical intervention must be conducted to raise the cure rate.