中西医结合治疗重症急性胰腺炎的临床研究(附1376例报告)

目的 探讨中西医结合治疗重症急性胰腺炎的新治疗方案和有效方法。方法 对不同研究阶段治疗重症急性胰腺炎的方案、方法和疗效进行回顾性对比分析，将历时24年的临床治疗研究分为三个阶段。第Ⅰ阶段(1980～1990年)，以早期手术治疗为主，中西医结合非手术治疗为辅；第Ⅱ阶段(1991～1993年)在中西医结合非手术治疗的基础上，强调并发症的中转手术治疗；第Ⅲ阶段(1994～2003年)以中西医结合非手术治疗为主要的治疗方法，手术治疗主要针对病程后期的感染和局部并发症的治疗。结果 随着中西医结合非手术治疗的不断完善，重症急性胰腺炎的手术率和病死率均明显下降。三个阶段的手术率分别为77．59％、54．54％和19．38％，而病死率则分别为40．52％、17．17％和10．77％。结论 中西医结合非手术治疗是有效的治疗方法，手术治疗是继发感染的主要治疗手段，早期手术指征应从严掌握。

Clinical Study on the Treatment of Severe Acute Pancreatitis by Integrated Traditional Chinese Medicine and Western Medicine

OBJECTIVE: To sum up clinical experiences and formulate a new treatment program for the effective managment of severe acute pancreatitis(SAP) by integrated TCM and western medicine. METHODS: The therapeutic regimens and end results of 1376 cases of SAP in three periods were reviewed and analyzed. Period I (1980-1990) was characterized by early surgical intervention supplemented with integrated traditional Chinese and western medical therapy, period II (1991-1993) by integrated traditional Chinese and western medical therapy supplemented with surgery for early complications, and period III (1994-2003) by integrated traditional Chinese and western medical therapy supplemented with surgery for local infectious complications at a late stage in the course of disease. RESULTS: With use of integrated traditional Chinese and western medical therapy in the treatment of SAP, the proportion of surgical operation and the case-fatality rate kept declining in the three consecutive periods, the proportions of operation being 77.59%, 54.54% and 19.38%, and the case-fatality rates being 40.52%, 17.17% and 10.77%, respectively. CONCLUSION: Integrated TCM and western medicine is effective for most SAP cases, and surgery is indicated mainly for late complications such as necrotizing infection. Early surgery should be handled with more circumspection and strictness in most of the patients with SAP.