高脂血症性重症急性胰腺炎综合治疗的探讨

目的探讨高脂血症性重症急性胰腺炎（HL-SAP）综合治疗的原则与措施。方法回顾性分析1996年1月至2000年12月和2001年1月至2006年8月两阶段收治的54例HL-SAP患者的临床资料。第一阶段（25例）患者采用常规降脂治疗或附加手术治疗;第二阶段（29例）患者采用多途径非手术综合治疗或附加以微创为主体的手术治疗。结果54例HL-SAP患者,非手术治疗33例（61．1％）,手术治疗21例（38．9％）,总病死率18．5％（10／54）。第一阶段患者的非手术治疗病死率21．4％（3／14）,手术治疗病死率36．4％（4／11）。第二阶段患者的非手术治疗病死率10．5％（2／19）,手术治疗病死率10％（1／10）。第二阶段患者在治愈率、总并发症发生率、病死率、第4天甘油三酯及慢性健康状况评分Ⅱ和平均住院时间方面与第一阶段相比均有明显改善（P〈0．05）。结论HL-SAP治疗应在遵循个体化治疗方案的前提下,充分重视多途径的非手术综合治疗措施,正确把握HL-SAP的外科干预时机与指征,术式的选择亦应遵循微创化原则,同时出院后密切监测并控制血脂。

Study on combined therapy of hyperlipidemic severe acute pancreatitis

OBJECTIVE: To investigate the principle and measures of combined treatment of the patients with hyperlipidemic severe acute pancreatitis (HL-SAP). METHODS: The clinical data of 54 patients with HL-SAP including two phases from January 1996 to December 2000 and from January 2001 to August 2006 were analyzed retrospectively. In the first phase, 25 patients were performed by routine methods to decrease triglyceride, or additional operative treatments. In the second phase, 29 cases were treated by multiple ways of non-operative combined therapy, or additional operative treatments mainly by minimally invasive procedures. RESULTS: Among 54 cases with HL-SAP, 33 cases (61.1%) received non-operative therapy and 21 cases (38.9%) received surgical intervention. Overall mortality was 18.5% (10/54). In the first phase of 25 cases, the mortality in non-operative group and surgical intervention group was 21.4% (3/14) and 36.3% (4/11), respectively. In the second phase of 29 cases, the mortality in non-operative group and surgical intervention group was 10.5% (2/19) and 10.0% (1/10), respectively. The overall curative rate, morbidity, overall mortality, content of triglyceride at the fourth day after onset, APACHE II score at the fourth day after onset and average stay were obviously improved in the second phase compared with the first phase (P < 0.05). CONCLUSIONS: According to individualized therapy principles, treatment for HL-SAP should emphasis on multiple ways of non-operative combined therapy and appropriate choices of the timing, indication in surgical intervention. And the choice of operative procedure should follow the principle of minimally invasive surgery. Meanwhile, pay more attention to monitoring and controlling the level of triglyceride post-discharge for the patients with the history of HL-SAP.