老年急性胰腺炎的临床分析

为探讨老年急性胰腺炎 (AP)的临床特点与有效的治疗方法 ,笔者回顾性分析 2 0 0例老年AP的临床资料。其中为轻症 1 2 6例 ,重症 74例。保守治疗 1 0 8例 ,轻症 89例均治愈 ,重症 1 9例死亡 9例 ;内窥镜下治疗 41例 ,轻症 4例、重症 37例均治愈 ;手术治疗 51例 ,轻症 33例均治愈 ;重症 1 8例死亡 8例。结果提示 :老年重症AP患者 ,更易出现多系统器官衰竭 ,病死率高 ;对急性胆源性胰腺炎早期行内镜治疗为安全有效治疗手段     

Acute pancreatitis

Acute pancreatitis is a common diagnosis and its incidence may be rising. The most common aetiological agents remain gallstones and alcohol misuse. Eighty per cent of patients will have a mild attack which resolves within a few days without specific treatment. Severe disease is characterized by a significant systemic inflammatory response which may be associated with varying degrees of organ dysfunction. The mortality in patients with multi-organ failure may be as high as 50%. This article reviews the definition, aetiology, pathophysiology, therapeutic strategies and outcomes in light of recent evidence and guidelines.     

Acute pancreatitis

In order to recognize acute pancreatitis in the setting of the acute abdomen, the surgeon must be thoroughly familiar with the numerous etiologies of the disease. No specific test is available to diagnose acute pancreatitis. CT scanning is arguably the most useful single tool, but surgical judgment is critical. Most cases of acute pancreatitis resolve spontaneously without sequelae, but the spectrum of the disease also includes highly lethal forms associated with a variety of systemic complications. Operative intervention is indicated when other, more rapidly fatal, abdominal processes cannot be reliably excluded and when local complications develop.     

Acute pancreatitis

The difficulty in differentiating between acute pancreatitis and other abdominal catastrophes is proven by the high incidence of diagnostic errors. It is most important to recognize perforations of peptic ulcers as immediate surgery is mandatory to good results. On the other hand, conservative treatment of acute pancreatitis gives a far lower mortality than that following early operative intervention. The determination of serum amylase levels has been a valuable addition to our diagnostic armamentarium as these rise sharply in the early stages of acute pancreatitis but are not increased in other acute abdominal conditions.The usual symptoms of acute pancreatitis are as follows: The history of acute abdominal pain varying in intensity and being most frequently located in the epigastrium and the right upper quadrant; tenderness and often rigidity in the area of the pain; nausea and vomiting invariably existing with shock accompanying severe attacks. There is often a history of previous milder attacks or of biliary colic. Jaundice is not infrequent. The leucocyte count is markedly elevated. Glycosuria and albuminuria frequently are found.Conservative therapy consists of relief of pain, rest in bed, continuous gastric rest and suction, adequate parenteral feedings to maintain blood chemistry and fluid balance, blood transfusions to overcome shock and careful observation. When the acute symptoms have subsided and the patient's condition has improved, biliary tract surgery should be contemplated if evidences of disease are found. Late drainage of pancreatic abscesses may be indicated.     

Acute pancreatitis

Acute pancreatitis is a common diagnosis and its incidence may be rising. The most common aetiological agents remain gallstones and alcohol misuse. Eighty per cent of patients will have a mild attack which resolves within a few days without specific treatment. Severe disease is characterized by a significant systemic inflammatory response which may be associated with varying degrees of organ dysfunction. The mortality in patients with multi-organ failure may be as high as 50%. This article reviews the definition, aetiology, pathophysiology, therapeutic strategies and outcomes in light of recent evidence.     

Acute pancreatitis

The diagnosis of acute pancreatitis is usually straightforward clinically and is confirmed by the demonstration of raised serum amylase or lipase. Disease severity has been defined by a consensus conference at the International Symposium on Acute Pancreatitis in Atlanta (USA) in 1992. The majority of patients with acute pancreatitis will have mild self-limiting disease that will resolve without complication. Patients with severe disease develop multiorgan dysfunction or local complications. Two phases of mortality are recognized: 50% of deaths occur in the first phase within the first week and are related to the effects of the systemic inflammatory response leading to multiorgan failure; deaths in the second phase are associated with infected complications. Over the past 30 years mortality has fallen in the early phase with improved organ support, but this has not been mirrored to the same extent by improved late-phase mortality. Aggressive investigation and management with critical care support is necessary for patients who develop severe disease. The indications for surgical intervention are well defined and many procedures may be performed minimally invasively, radiologically or by a combination of both approaches.     

Acute pancreatitis

Acute pancreatitis is a common diagnosis and its incidence may be rising. The commonest aetiological agents remain gallstones and alcohol misuse. Eighty percent of patients will have a mild attack which resolves within a few days without specific treatment. Severe disease is characterized by a significant systemic inflammatory response which may be associated with varying degrees of organ dysfunction. The mortality in patients with multi-organ failure may be as high as 50%.     

Acute pancreatitis

Acute pancreatitis is a common diagnosis and its incidence may be rising. The most common aetiological agents remain gallstones and alcohol misuse. Eighty per cent of patients will have a mild attack which resolves within a few days without specific treatment. Severe disease is characterized by a significant systemic inflammatory response which may be associated with varying degrees of organ dysfunction. The mortality in patients with multiorgan failure may be as high as 50%. This article reviews the definition, aetiology, pathophysiology, therapeutic strategies and outcomes in light of recent evidence and guidelines.     

Acute pancreatitis

This paper provides a review of recent advances in the understanding and management of acute pancreatitis. The mortality of acute severe pancreatitis remains disappointingly high. While there have been relatively few recent advances in the surgical management of acute pancreatitis, several nonsurgical developments appear promising.     

Acute pancreatitis in children

Twenty-nine children with acute pancreatitis were managed during the period 1971 to 1983. Aetiology included trauma (5), mumps (5), drug therapy (4), biliary disease (1), and cystic fibrosis (1); 13 cases were classified as idiopathic. Diagnosis could be difficult, and unnecessary laparotomies were performed in 7 instances for suspected appendicitis. One patient, however, had a well-justified laparotomy revealing coexisting severe appendicitis and pancreatitis. Morbidity included relapses (7), pseudocysts (3), obstructive duodenal hematoma (1), and miscellaneous problems (4). Improvements in management included endoscopic retrograde cholangio-pancreatography (ERCP) to exclude anatomical anomalies in relapsing cases, ultrasonography for the diagnosis of pseudocysts and for follow-up measurements in two such cases successfully managed conservatively, and increasing use of total parenteral nutrition in cases with protracted disease or serious complications.