区域动脉灌注在胆石性胰腺炎治疗中的应用

目的探讨区域动脉灌注疗法在胆石性胰腺炎临床治疗中的应用效果。方法比较区域动脉灌注疗法与早期手术、传统非手术方法治疗胆石性胰腺炎的疗效，并分析死因与治疗要点。结果①I型、Ⅱ型、Ⅲ型、Ⅳ型的病死率分别为0（0／70）、0（0／146）、10％（1／10）、17．0％（8／47），Ⅳ型病死率最高，与其他三组相比差异有统计学意义（P〈0．05）。Ⅳ型占总病死患者的88．9％（8／9）。②早期手术、传统非手术方法、早期区域动脉灌注疗法治疗Ⅳ型患者的病死率分别为30．8％（4／13）、25．0％（3／12）、4．5％（1／22），区域动脉灌注组病死率最低，差异有统计学意义（P〈0．05）。③除区域动脉灌注组的1例患者死于后期感染并发症，其他组的8例患者均死于多脏器衰竭。结论早期区域动脉灌注疗法是治疗IV型（非梗阻性重型）胆石性胰腺炎的理想选择。在治疗过程中，应注意Ⅳ型向Ⅲ型（梗阻性重型）胆石性胰腺炎的转变，并应常规检查Ⅳ患者的血脂。

Application of regional intra-arterial infusion in gallstone pancreatitis

Objective To study the application of regional intra- arterial infusion（RIAI） therapy in the treatment of gallstone pancreatitis. Methods The therapeutic effectiveness of early operation,traditional nonoperative measures and RIAI were compared. Besides the causes of death and the key points of treatment were analyzed. Results ①The mortality of type I , type Ⅱ, type Ⅲ, type Ⅳ gallstone pancreatitis was 0 （ 0/146 ）, 0 （ 0/70 ）, 10 % （ 1 / 10 ）, 17.0 % （ 8/47 ）, respectively The mortality of type IV gallstone pancreatitis was the highest, accounting for 88.9% （ 8/9 ） of total death cases ; The difference had statisti- cal meaning（P 〈0.05 ）. ②The mortality of type IV gallstone pancrtititis in early operation group, traditional conservative group and RIAI group was 30.8% （4/13） ,25.0% （3/12） ,4.5% （ 1/22 ）, respectively, and that in RIAI group was the lowest, and the difference had statistical meaning（ P 〈 0.05 ）. ③Besides 1 case of type Ⅳ in RIAI group died from infectious complication at late stage ,8 cases in other therapeutic groups all died due to multi - organ failure. Conclusion RIAI at early stage is an ideal therapeutic meth- od for type IV gallstone. During treatment, the conversion of type IV into type 11 should be paid attention, and the serum lipids of patients with type IV gallstone pancreatitis should be inspected as a routine examination.