非手术治疗急性重症胆源性胰腺炎

目的 探讨急性重症胆源性胰腺炎非手术治疗的效果和中转手术的指征。方法 回顾分析本院收治157例急性重症胆源性胰腺炎非手术治疗的死亡率、并发症和中转手术的情况。结果 157例中治愈145例，死亡12例，治愈率92．4％。治疗过程中有65例出现各类并发症，其中多器官功能不全或衰竭18例(11．5％)，坏死组织继发感染6例(3．8％)，胰腺假性囊肿29例(18．5％)，急性肺损伤25例。患预后与人院时APACHE—Ⅱ评分有关。有9例中转手术(5．7％)，包括6例胰腺坏死组织继发感染和2例不能控制的胆道感染。梗阻性和非梗阻性重症胆源性胰腺炎在死亡率和胰腺坏死组织继发感染发生率上相似。结论 急性重症胆源性胰腺炎经积极非手术治疗可获得满意疗效。梗阻性急性重症胆源性胰腺炎当存在不能控制的胆道感染时需早期行胆道手术。中转手术的指征为胰腺坏死组织继发感染、不能控制的胆道感染及治疗期间出现其他外科并发症。

Nonsurgical treatment for severe acute biliary pancreatitis.

Objective To discuss the outcome of conservative treatment for severe acute biliary pancreatitis and indication for transfer to surgical intervention. Methods A total of 157 patients with severe acute biliary pancreatitis were admitted in our department between May 1991 and Dec. 2001. The mortality, morbidity and indication of surgical intervention were retrospectively studied. Results Of the 157 patients with severe acute biliary pancreatitis, 145 patients (92. 4%) were cured and the remaining 12 patients(7. 6%) died. Various complications were found in 65 patients(41. 4%) during the course of management, which included multiple organ dysfunction syndrome/multiple organ failure (18), pancreatic infection(6) and pancreatic pseudocyst(29). Nine patients(5. 7%) were transferred to surgical intervention because of pancreatic infection and uncontrollable biliary infection. Conclusions The outcome of positive conservative treatment for severe acute biliary pancreatitis was satisfactory even in patients with MODS or bile duct obstruction. Antibiotic treatment is necessary. Patients with uncontrollable biliary infection appear to be the only subgroup who may benefit from emergency biliary intervention. For patients with infected necrosis, surgical treatment should be considered without delay.