重症胰腺炎手术指征和手术时机的探讨

目的 探讨重症且腺炎的手术指征和手术时机。方法 回顾性分析８２例重症胰腺炎的治疗情况，其中行非手术治疗１０例、早期手术４４例、延期手术２８例。结果 本组总并发症发生率为２４％、总病死率为１８％。非手术组１０例均痊愈，并发症发生率为１０％；早期手术组死亡５例，并发症经和病死率分别为１４％和１１％；延期手术组死亡１０例，并发症发生率和病死率分别为４６％和３６％，两组相比差异有显著意义（Ｐ＜０.０１、Ｐ＜０.０５）。延期手术组中，无明显感染者其并发症发生率和病死率明显低于有严重感染及重要器官功能不全者（Ｐ＜０.０１、Ｐ＜０.０５）。结论 早期手术治疗对于一些重症胰腺炎患者仍然是必需的。胰腺坏死广泛者宜在发生严惩感染前进行手术。

The indication and timing of surgery for acute necrotizing pancreatitis

Objective　 To investigate the indication and timing of surgery for acute necrotizing pancreatitis.　 Methods　 82 cases of acute necrotizing pancreatitis were analyzed retrospectively. 10 cases were treated non-operatively. Early operation was performed on 44 cases, while 28 cases underwent surgery on late stage.　 Results　 The overall morbidity and mortality was 24% and 18%, respectively. All 10 patients in the non-operative group were cured with a morbidity of 10%. The morbidity and mortality in the early operation group was 14% and 11%, respectively, compared with 46% and 36% of those receiving surgery on late stage（P＜0.01, P＜0.05）. Among those in late surgery group, patients not complicating infection had significant lower morbidity and mortality rate than those suffering from severe infection or organ dysfunction（P＜0.01, P＜0.05）.　 Conclusions　 Early operation is necessary for some severe cases.In patients with severe pancreatic necrosis surgery should be performed before severe infection occurs.