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急性坏死性胰腺炎外科治疗20年经验总结
引用本文:袁祖荣,张臣烈.急性坏死性胰腺炎外科治疗20年经验总结[J].中华外科杂志,1997,35(3):132-134.
作者姓名:袁祖荣  张臣烈
作者单位:上海第二医科大学附属瑞金医院外科
摘    要:作者总结了1974年8月~1994年11月243例急性坏死性胰腺炎外科治疗的经验。按治疗观点及治疗方式分为三个阶段。第一阶段为针对胰腺坏死作早期彻底切除坏死组织手术,辅以“三造瘘”、“创口敞开”、“局部灌洗”等措施。治愈率为61.3%。第二阶段以坏死是否伴有感染为指征的“个体化治疗”,即对感染者作手术治疗,对非感染者作保守治疗,治愈率提高到68.5%。第三阶段治疗有二个特点。第一是在手术时间上强调后期手术,如在严密的治疗观察下感染能缓解控制,可延缓到后期手术;对有恶化倾向者,则作早期或急诊手术。第二是建立综合治疗体系,依靠多学科的参与,使手术治愈率提高到80%,非手术治愈率达到100%,总治愈率为83.1%。

关 键 词:胰腺炎  外科手术  综合疗法

A 20 year experience in surgical management of acute necrotizing pancreatitis
Yuan Zurong,Zhang Chenglie,Tang Yaoqing,et al..A 20 year experience in surgical management of acute necrotizing pancreatitis[J].Chinese Journal of Surgery,1997,35(3):132-134.
Authors:Yuan Zurong  Zhang Chenglie  Tang Yaoqing  
Institution:Department of Surgery, Ruijin Hospital, Shanghai Second Medical University.
Abstract:From 1974 to 1994, 243 patients with acute necrotizing pancreatitis (ANP) proved by operation or CT scanning system were treated. The overall survival rate was 70.4%. In 1974-1987, the resection of necrosis was radical and as early as possible, and the main type of operation was subtotal pancreatectomy. The survival rate in this period was 61.3% (49/80). In 1988-1991, the treatment was changed into "individualization" i.e. for sterile pancreatic necrosis, conservative treatment was setected while infected pancreatic necrosis, necrosectomy was performed early. In this period, the survival rate of conservative treatment was 85.7% (6/7) and that of operative treatment 67.1%. The overall survival rate in was 68.5% (63/92). In 1991-1994, we insisted on late operation for the patients with necrosis and comprehensive management for all the patients with ANP. The survival rate of conservative treatment in this period was 100% (11/11) and that of operative treatment 80% (48/60). The overall survival rate was 83.1% (59/71). We conclude that comprehensive management combined with late operation for the patients with necrosis infected is a better strategy for the treatment of ANP.
Keywords:Pancreatitis    Surgery  operative    Combined modality therapy  
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