急性出血坏死性胰腺炎非手术治疗的关键环节

作者１９７０年１月至１９９６年８月共收治急性出血坏死性胰腺炎（ＡＨＮＰ）１６６例。１９８０年以前以简化手术为主，１９８０～１９９０年以经典手术为主，１９９０年以后以非手术治疗为主。在当今ＩＣＵ条件下，多数ＡＨＮＰ患者可以经积极的非手术治愈，但不是所有的患者所有的时候都要坚持非手术治疗。非手术治疗组的各种并发症及死亡率均低于手术治疗组（Ｐ＜０．０５）。并发症急性呼吸窘迫综合征（ＡＲＤＳ）、胰腺脓肿、腹腔出血可能和手术打击有关。因此非手术治疗值得提倡和推广。总结非手术治疗的经验，我们认为采用非手术治疗前，ＡＨＮＰ的诊断必须明确，病程的不同时期有不同的治疗重点：病程早期（发病１周内）以纠正内环境紊乱及减轻胰外器官损害为主；中期（发病２～４周内）以防治胰腺坏死组织继发感染为主；后期（发病４周后）以处理胰腺坏死组织引起的并发症为主。

The key to the nonoperative management for acute hemorrhagic necrotizing pancreatitis:experience with 88 cases

A total of 166 patients with acute hemorrhagic necrotizing pancreatitis(AHNP) were treated in our department from 1970 to 1996.Most patients before 1990 were operated while managed with nonoperative methods after 1990. With the modern ICU equipments and conditions,most of the AHNP patients can be cured with the conservative treatment. The complications and mortality in the nonoperative group are less than those in the operative group significantly(P<0.05).ARDS,pancreatic abscess,abdominal hemorrhage may be caused by the operative attack.AHNP patients should be managed according to the stage of the disease:at the early stage(the first week),it is mainly to correct the disorders of the millieu interne and to reduce the damage of the extrapancreatic organs.At the middle stage(the second to the fourth weeks)mainly to prevent and to treat the panceratic infection; At the later stage(after the fourth week),mainly to deal with the complications.