重症胰腺炎外科治疗的对策

目的探讨重症急性胰腺炎（ＳＡＰ）外科治疗方法和对策。方法对３４例ＳＡＰ的非手术和手术治疗观察，就适应证、并发症、病死率、治愈率、治疗效果和再手术原因进行了分析总结。结果①ＳＡＰ早期中毒性休克是由细胞因子和血管活性物质等所致，经非手术治疗好转。②肠道细菌移位是导致继发感染和死亡的重要原因，预防使用抗生素和消化道去污，可减少感染。③胰周并发感染时应手术引流，手术不宜求大，否则会增加并发症和死亡率。有效胰周减压和清除坏死组织，彻底腹腔冲洗和引流，能提高疗效。结论ＳＡＰ早期应根据病情而选择治疗方案。如需手术，则范围不宜扩大。

Surgicl countermeasures in treatment of severe acute pancreatitis

Objective The purpose of this study was to explore the proper surgical methods and countermeasmes in treatment of severe acute pancreatitis (SAP). Mathod We summarised the indication, complication, mortality, curability, curative effect and the causes Of re-operation for SAP by analyzing 34 non-operation and operation patients. Results The early toxic shock in SAP was resulted from the activities of cytokines, vasoactive sub stances etc, and recovered with non-operation treatment. The bacterial shifting in enteron was very important forthe occurrence of secondary infection and death, which could be adduced by using antibiotic and dative tractscour. Peripancreatic infection shauld be clrained by operation, which could increase the heatment efficiency byproper decrease of peripancreatic pressure, discharge of necrotic tissue, thororgh wash and drainage of abdominal cavity. However, if the operation was extensive and thorough, it would bring about more complications and highermortality. Conclusion We conclude that the treatment method should be selected according to the patient's condition. The operation isn' t the only choice. The operation area should not be large during necessary operation.