119例重症急性胰腺炎的治疗方法与效果分析

目的 探讨重症急性胰腺炎severe acute pancreatitis，SAP）治疗方法与效果的关系。方法 将119例SAP作一回顾性分析。结果 手术治疗组与非手术治疗组的平均APACHEII评分分别为13．5±4．7和13．1±3．9，两组病情严重程度差异无统计学意义（P〉0．05）；平均病程分别为（51.4±40．3）d、（34．2±23．4）d，并发症发生率分别为48．8％（20／41）、37．2％（29／78），病死率分别为26．8％（11／41）、11．5％（9／78）。两组比较，平均病程差异有统计学意义（P〈0．01），并发症发生率差异无统计学意义（P〈0．05），病死率差异有统计学意义（P〈0．05）。结论 对不伴胆道梗阻的SAP，以非手术治疗为主的个体化原则，综合治疗效果明显优于早期手术治疗：SAP伴有胆道梗阻者应急诊行EST、ENBD或开腹手术解除梗阻。

Analysis of the therapeutic method and effect on outcome of patients with severe acute pancreatitis in 119 cases

Objective To explore the therapeutic method and effect on outcome of patients with SAP. Methods The clinical data of 119 cases of SAP were retrospectively studied. Results In control study between operative and non-operative treatments, the score of the APACHE II was 13.5±4.7 vs 13.1±3.9 （P〉 0.05）, the severity of SAP in two groups had no difference, the mean hospitalized day was （51.4±40.3） days vs （34.2±23.4）days, the incidences of complications were 48.8%（20/41） vs 37.2%（29/78）, the mortality rates were 26.8%（11/41） vs 11.5%（9/78）. The mean hospitalized day and the mortality in non-operative group were fewer than those in operative group （P〈0.05）. Conclusion For SAP without biliary obstruction, the effect of individual systematic therapy is superior to early operation. Endoscopic or surgical biliary drainage should be performed urgently for patients with biliary SAP accompanied with biliary obstruction.