重症急性胰腺炎的外科治疗：附36例报告

目的：探讨外科手术在重症急性胰腺炎（SAP）治疗中的作用。方法：回顾性分析2009年6月—2012年8月接受手术治疗的36例SAP患者的临床资料及治疗效果。结果：胆源性SAP 11例（30.5%），妊娠期SAP 2例（5.6%），酗酒或暴饮暴食者20例（55.6%），其他诱因3例（8.3%）。早期手术9例（25.0%），其中行胆囊切除、胆总管切开取石、T管引流、腹腔冲洗引流术7例，剖腹探查、胰腺区冲洗引流术2例；延期手术27例（75.0%），均行胰腺坏死组织清除、腹腔冲洗引流术，其中4例同时行胆囊切除、胆总管切开取石、T管引流术。2例死于多器官功能障碍综合征（MODS）及败血症，3例中途退院而失访，其余患者恢复良好，顺利出院。结论：手术是SAP治疗的关键环节之一，掌握恰当的手术时机和手术方式，可以有效降低并发症，提高疗效，挽救危重患者的生命。

Surgical management of severe acute pancreatitis: a report of 36 cases

Objective: To evaluate the efficacy of surgical intervention in the treatment of severe acute pancreatitis (SAP). Methods: The clinical data and results of 36 SAP patients undergoing surgical treatment from June 2009 to August 2012 were retrospectively analyzed. Results: Among the 36 SAP patients, 11 cases (30.5%) were caused by biliary factors, 2 cases (5.6%) were associated with pregnancy, 20 cases (55.6%) were due to alcohol abuse or overeating, and 3 cases were induced by other causes. Nine patients (25.0%) received early operation, of whom, 7 cases underwent cholecystectomy, choledocholithotomy, T-tube drainage, and peritoneal lavage, while 2 cases underwent exploratory laparotomy and irrigation/drainage of the pancreatic bed. Twenty-seven patients received delayed operation; all of them underwent pancreatic necrosectomy and peritoneal lavage, and in 4 cases cholecystectomy, choledocholithotomy and T-tube drainage were simultaneously performed. Two patients died of multiple organ dysfunction syndrome (MODS) and sepsis, 3 patients refused continued hospitalization and were lost to follow-up because of noncompliance, and all other patients were discharged after full recovery. Conclusion: Surgery is an important component in the treatment of SAP; appropriate timing and surgical treatment methods can reduce complications, improve therapeutic efficacy, and save the lives of critically ill patients.