胆石性胰腺炎的临床治疗

目的探讨胆石性胰腺炎的临床处理要点。方法依据是否存在胆道梗阻和胰腺炎病变严重度将273例胆石性胰腺炎分为四个临床类型,分别对各类型的临床资料进行分析。结果（1）梗阻性重型10例,早期手术8例,全部治愈;传统保守治疗2例,其中1例死于早期多脏器功能衰竭。（2）梗阻性轻型70例,早期手术57例,ERCP＋EST 4例,传统保守治疗9例,全组无死亡。（3）非梗阻性重型共47例,13例采用早期手术,4例死于早期多脏器功能衰竭;22例采用早期区域动脉灌注治疗,1例死于后期感染并发症,12例保守治疗,其中4例病情较重,3例死于早期多脏器功能衰竭。（4）非梗阻性轻型146例,早期手术55例,后期手术8例,ERCP＋EST 3例,内科保守80例,全组无病死。结论（1）梗阻性重型患者应采用早期手术治疗。（2）梗阻性轻型患者可采用早期手术或EST解除胆道梗阻以防止胰腺炎加重。（3）推荐应用早期区域动脉灌注治疗非梗阻性重型患者,适当地联合手术有助于疗效的提高。（4）保守治疗成功者应适时地手术解决胆石症以防止胰腺炎复发。（5）治疗过程中应注意各临床类型之间的转变,及时调整治疗方案。

The clinical treatment of pancreatitis with coexisted gallstones

Objective To study the clinical treatment of gallstone pancreatitis. Methods In this study, 273 cases of cholelithic pancreatitis were classified into four clinical types according to the existence of biliary obstruction and the severity of pancreatitis. Results (1 ) 10 cases were of severe gallstone pancreatitis (SGP) with cholangitis, in which 8 cases underwent operations in early stage, and were cured. The other 2 cases were treated conservatively, with 1 case dying of multiple organ failure. (2) 70 cases were of mild gallstone pancreatitis ( MGP) with cholangitis, among them, 57 cases underwent operations, 4 cases underwent ERCP combining with EST, 9 cases were treated with conservative methods. There were no deaths in this group. (3)47 cases were of SGP without cholangitis. 13 cases underwent surgery in early stage, 4 cases died of multiple organ failure in early stage; 22 cases underwent regional intra-arterial infusion, 1 case died of infectious complication; 12 cases were treated by traditional conservative methods, 3 cases died of multiple organ failure in early stage. (4) 146 cases were of MGP without cholangitis, 55 cases underwent operations in early stage, 8 cases underwent operations in late stage, ERCP combining with EST were performed in 3 cases, and 80 cases received traditional conservative methods. There were no deaths in this group. Conclusions (1) Surgery for SGP with cholangitis should be performed in early stage. (2) EST or operation is recommended for MGP with cholangitis. (3) Regional intra-arterial infusion is recommended for SGP without cholangitis. Surgery could save lifes when indicated. (4) The operation aimed at cholecystolithiasis is recommended for the prevention of the recurrence of pancreatitis, (5 ) The exacerbation of clinical symptom always calls for the adoption of new treatment strategy.