急性出血坏死性胰腺炎的临床治疗体会

目的 :探讨急性出血坏死性胰腺炎 (AHNP)的早期诊断和治疗。方法 :将AHNP 90例随机分为治疗组和对照组各 45例 ,治疗组强调保守治疗 ,使用生长抑素、1,6 二磷酸果糖、糖皮质激素、无肾毒性广谱抗生素和全静脉内营养疗法等 ,如有手术指征 ,就积极手术 ,基本术式是三造瘘、胰包膜切开、坏死组织清除、胰腺周围和腹腔引流等 ;对照组以手术为主 ,保守治疗为辅作对照 ,然后两组进行比较分析。结果 :治疗组死亡 5例 ,病死率为 11.1% ;对照组死亡 13例 ,病死率为 2 8.9% ,两组比较有显著性差异 (P <0 .0 5 )。结论 :AHNP之早期诊断有着重要的临床意义。治疗上首先强调保守治疗 ,并掌握手术指征及时手术 ,以降低其病死率

Clinical study on 45 cases with acute hemorrhagic necrotic pancreatitis

Objective:To study the early diagnosis and treatment for acute hemorrhagic necrotic pancreatitis (AHNP).Methods:All the informations of 90 patients with AHNP were analysed to find key points in the diagnosis and treatment.90 patients with AHNP were divided randomly into two groups,Group A included 45 patients who got treated with non operation as first choice,Group B was a comparison with 45 patients who got treated with operation as first choice.The two groups had no identical differences.Results:40 cases of Group A were successfully diagnosed and treated,the mortality was 11.1%.Among them,19 cases were treated with operations,including triple fistulization,incision and drainge,and the other 26 cases were treated with non operation,including Somatostatin,Fructose 1,6 Diphosphate,Adrenocortical hormones,broad spectrum antibiotics and Total Parenteral Nutrition.The clinical curative efficacy of Group A was superior significantly to Group B (P<0.05).Conclusion:In order to lower the mortality,early diagnosis and proper treatment were very important.The treatment of non operation was the first choice,but operations were necessary as soon as the indications emerge.