重症胰腺炎的手术时机确定和手术方法改进

目的 寻找有效治疗重症胰腺炎的手术时机和良好的手术方法。方法 治疗分两个阶段:第一阶段,共17例,为1990年1月-1992年6月间收治的重症胰腺炎患者。（1）手术组:8例血性腹水,按传统手术方法手术;（2）非手术组:9例未抽出明显腹水,行保守治疗。第二阶段:78例,为1992年7月-1999年8月间收治的重症胰腺炎患者。其中67例经腹腔穿刺抽出血性腹水的患者按双盲法随机分为两组:（1）单纯腹腔置管术组:35例。（2）改良手术组:32例,该组患者行胆囊切除、胆总管探查、空肠造瘘及大网膜切除术。（3）非手术组:11例经腹腔穿刺未抽出明显腹水,采用保守治疗。结果 第一阶段:（1）手术组:8例中死亡7例,存活1例。（2）非手术组:9例全部存活。第二阶段:（1）单纯腹腔置管术组:35例患者中,4例术后死亡,31例存活,其中6例出现假性囊肿。（2）改良手术组:32例均未行第二次手术,无假性囊肿形成。（3）保守治疗组:11例全部存活。结论 重症胰腺炎的手术时机应该是:在任何时候经腹腔内抽出血性腹水,就应及时手术;重症胰腺炎的手术方式应是:尽可能不于扰胰腺,保持胰腺的完整性。

Time and methods of operation about treating severe pancreatitis

Objective Try to find out the time surgical methods for treating severe pancreatitis. Methods The methods of treatment were divided into two stages. The first stage was from January 1990 to June 1992. There were seventeen patients with severe pancreatitis. They were divided into two groups, (1) Operation group: 8 patients were punctured into their abdomens, bloody obliquid was obtained. They were treated with traditional operations. (2) Non- operation group: 9 patients were punctured into their abdomen, no liquid was found. They were treated with non- operative methods. The second stage was from July 1992 to August 1999. There were seventy - eight patients with severe pancreatitis. Among of them, 67 patients who were punctured into their abdomens and got bloody liquid were divided into two groups by double - blind study. (1) Group 1: In 35 patients, tubes were inserted into their abdomen. They were lavaged into the tubes. (2) Group 2: 32 patients were operated with cholecystectomy, choledocho-stomy, jejunostomy and removal of greatoromentum. Their pancreas were not disturbed during operation. (3) Group 3: among the 78 cases, 11 patients were punctured into their abdomens. No fluid was obtained. They were treated with non - operative methods. Results In the first stage, (1) Operation group: seven patients died, only one survived. (2) Non - operation group: all of the nine patients survived. In the second stage, (1) Group 1: Among the 35 patients, 4 patients died, but 31 patients survived. (2) Group 2: All of the 32 patients survived. They did not have second operation. (3) Group 3: All of the 11 patients survived. Conclusions The time for operation in the treatment of severe pancreatitis should be that when bloody fluid was obtained through abdominal puncture at any time. The better operation to treat severe pancreatitis was that the operator should not disturb the pancreas during the operation. He should keep the pancreatic intact.