急性胆源性胰腺炎167例外科治疗分析

目的　探讨急性胆源性胰腺炎 (AGP)的合理诊治方法。方法　回顾分析 167例AGP资料并将其分为重型组 ( 4 9例 )和轻型组 ( 118例 ) ,分析胆道梗阻情况、外科手术时机及术后并发症对死亡率的影响。结果　入院时有否梗阻病死率无差别 (P >0 .0 5 ) ,梗阻时间 >48h者病死率高于 <48h者 ( P <0 .0 5 ) ;重症AGP早期手术死亡率高于延期手术 ( P <0 .0 5 ) ;轻症AGP早晚期手术间病死率无统计学差异 (P >0 .0 5 ) ;术后胰腺感染和MODS是AGP的主要死因。结论　入院时壶腹部梗阻不是AGP手术指征 ,若梗阻持续不能解除 ( >48h)则考虑手术 ;重症AGP慎行早期手术 ;预防并及时处理并发症是降低AGP病死率的关键。

Analysis of surgery treatment for 167 cases of acute gallstone pancreatitis

Objective To explore proper treatment for acute gallstone pancreatitis(AGP).Methods 167 cases of AGP was analyzed retrospectively and divided into severe group (49 cases) and mild group (118 cases),relation between mortality and bile duct obstruction and surgery treatment timing and complications was statistically evaluated.Results Mortality was not significant between the obstruction group and non abstrustion group(P>0.05),A higher nortality was foun in group whose obstruction continued more than 48 hours than that of less than 48 hours (P<0.05);Severe AGP group that accepted early surgery treatment has higher death rate than that of delayed surgery group(P<0.05),but no difference between the two in mild AGP.Pancreas infection and MODS after surgery the main cause of death.Conclusions Obstruction of Vater's ampulla within the early 48 hours should not be the sign for operation,which should be carried out if obstruction continued more than 48 hours;Early timing surgery treatment should be carefully taken for the severe cases in early stage;Preventing and properly treating various complications are key factors to reduce death rate.