重症急性胰腺炎的手术治疗探讨

目的 探讨重症急性胰腺炎的手术治疗和非手术疗法转手术治疗的指征和时机。方法 回顾性分析1996年1月至1999年12月收治的重症急性胰腺炎213例。结果 重症胆源性胰腺炎手术治疗52例，治愈率为92%。死亡病例平均生存31d，主要死亡原因是多器官功能衰竭（MODS）和胰腺坏死感染；非手术治疗43例，治愈率为88%。死亡病例平均生存3d，主要死亡原因为中毒性休克、严重感染和MODS。重症非胆源性胰腺炎手术治疗65例，治愈率为75%。死亡病例平均生存56d，死亡原因有MODS、感染、消化道瘘和腹腔内出血；非手术治疗56例，治愈率89%。死亡病例平均生存8d。早期死亡的原因有休克、肾功能衰竭和呼吸衰竭等，后期死亡的原因主要是感染。结论（1）胆源性胰腺炎有胆道梗阻者应行急诊手术，出现坏死感染也需手术治疗；（2）非胆源性胰腺炎宜先采用非手术治疗。出现坏死感染者需要手术治疗，对病情迅速恶化者也应及时手术引流；（3）胰腺的包裹坏死液化感染需要手术治疗。

Indication and timing for operation in severe acute pancreatitis

Objective To investigate the indication an d timing for operation in severe acute pancreatitis. M ethod The clinical data of 213 patients with severe acute pancr eatitis treated in our hospital were analyzed. Resul ts Fifty two cases of severe biliary pancreatitis were treated operatively with survival rate of 92%, in which the death cases had a mean su rvival time of 31 days. 43 cases were treated nonoperatively with survival rate of 88%, in which death cases had a mean survival time of 3 days. Sixty five case s of non-biliary pancreatitis were treated operatively with survival rate of 75 %, in which the death cases had a mean survival time of 56 days. 56 cases were treated nonoperativly with survival rate of 89%, in which the death cases had a mean survival time of 8 days.Conclusion (1)Pancreatitis with biliary obstruction should be treated by urgent surgery, in those with infected necrosis a surgery is also indicated.(2) In no n-biliary pancreatitis, nonoperative therapy should be adopted unless there is a sign o f severe peritonitis. Moreover, patients with rapid deteriorated clinical condit ions should undergo exploration. (3) Localized infected necrosis is indicated fo r operation.