外科治疗急性坏死性胰腺炎-14年经验总结

目的分析急性坏死性胰腺炎(ANP)术后死亡的原因,探讨ANP的手术指征和合理的手术方式。方法将手术治疗ANP112例分成死亡组和存活组,对有关预后的指标进行对比和统计学分析。结果两组病人的平均年龄、性别比例和起病时间比较接近,早期休克、成人呼吸窘迫综合症(ARDS)、发热、血象和高血糖的发生率在两组间没有明是差异(P均>0.05)。与死亡有关的主要因素有①胰腺的坏死程度;②手术方式不正确;③手术指征不妥。结论轻、中度ANP应该首先试行非手术治疗48~72h。术前早期休克和ARDS应该及时纠正。术中应该充分游离肿胀的胰腺,有利于术后充分引流。建议行十二指肠造口术。

Surgical treatment for acute necrotizing pancreatitis:14 years' experience in a single Chinese Center

Objective:To investigate the reasonable approach and surgical indication for acute necrotizing pancreatitis(ANP)by analyzing the factors that affecting the mortality of ANP.Methods:One hundred and twelve patients with ANP were retrospectively divided into two groups-the dead and the survivors.Some parameters were analyzed statistically to reveal what's the reason for death.Results:The average age,sex ratio and onset of illness were similar between two groups.And the ratio of early shock,early adult respiratory distress syndrome (ARDS),high temperature,leukocytosis and high blood glucose between two groups were also similar between two groups(P＞0.05,respectively).The important factors that affecting the mortality were:①severity of pancreatic necrosis,②improper surgical approach,③incorrect surgical indication.Conclusion:The patiets with mild or moderate ANP should mainly receive conservative treatment for 48～72 hours.The early shock and ARDS should be redressed before surgical intervention.If the operation is unavoidable,the swelling pancreas should be dissected fully,which will provide sufficient drainage after operation,and duodenostomy should be performed during operation.