广东地区1316例急性胰腺炎的临床流行病学特征

目的探讨广东地区急性胰腺炎（AP）的临床特点和发病规律。方法总结分析中山大学附属第二医院及广东省人民医院1986—2005年AP住院患者共1316例临床资料,并对结果进行统计分析。结果1986—1990年间病例数占同期内、外科住院总人数的0．19％,1991—1995年间上升为0．36％,1996—2000年间升至0．54％,而2001—2005年间则高达为0．71％。1316例患者中胆源性胰腺炎占60．48％,其余依次为高脂血症胰腺炎、特发性胰腺炎。临床症状以上腹部疼痛为主,伴或不伴腰背部放射痛,多数伴有恶心、呕吐等消化道症状。动态增强CT扫描是明确诊断、严重度分级及发现并发症的准确影像学方法。非手术治疗1104例,死亡24例;手术治疗212例,死亡48例。结论AP发病例数逐年增多,AP发病因素多而复杂,胆道疾病仍为主要病因。影像学检查有助于早期诊断及严重度分级,早期治疗可采用中西医结合的非手术疗法,严格掌握手术指征,合理使用内镜技术,均能取得理想的治疗效果。

The epidemiological and clinical characteristics of 1316 cases of acute pancreatitis in Guangdong region

OBJECTIVE: To explore the clinical characteristics and pathogenetic patterns of acute pancreatitis (AP) in Guangdong region. METHODS: Analysis and summary of the clinical data of 1316 AP patients admitted into the Sun Yat-sen Memorial Hospital of Sun Yat-sen University and the Guangdong Provincial People's Hospital between 1986 and 2005 were made. RESULTS: The AP rates among 1986 - 1990, 1991 - 995, 1996 - 2000, 2001 - 2005 year subsections were 0.19%, 0.36%, 0.54% and 0.71%, respectively. 60.48% of the cases was associated with biliary tract disease and the rest were related to hyperlipidemic, idiopathic and alcoholic factors. Epigastric pain was the predominant clinical manifestation, with or without radiating lumbar and back pain. Digestive manifestations such as nausea and vomiting appeared in most of the patients. Contrast-enhanced dynamic computed tomography was a precise imaging technique for diagnosis and severity grading as well as for complication detection. 1104 patients received nonoperative treatment (integrated traditional and western medicine) with 24 deaths. 212 patients received operative treatment with 48 deaths. CONCLUSIONS: The incidence of AP increased in the recent 20 years. The pathogenesis of AP is numerous and complicated, and biliary tract disease is still the main etiology. The imaging techniques are beneficial for early diagnosis and severity grading. Nonsurgical treatment integrating traditional and western medicine should be applied for early therapy. Strictly handling the indications for surgery, avoiding early surgery and rationally using endoscopic technique may help to gain satisfactory therapeutic efficacy.