重症急性胰腺炎的治疗体会(附67例临床分析)

为了探讨重症急性胰腺炎的非手术治疗措施及手术指征的选择,对67例重症急性胰腺炎患者进行回顾性分析,住院后均先于监护室进行非手术综合治疗措施,包括补充血容量、减少胰腺分泌及去除炎症介质、重要脏器功能的支持、防治感染及促进胃肠道功能恢复等。在非手术治疗过程中,中转手术和急诊手术29例,其中中转手术12例(包括胆系疾病3例,胰腺感染6例,麻痹性肠梗阻3例,1例死于DIC和MSOF);急诊手术17例(死亡2例,死于MSOF)。非手术治疗38例,除1例为暴发性病例死亡外,余均治愈出院,总死亡率为5.97%。由此可见,重症急性胰腺炎经积极、有效的综合非手术治疗是可以治愈的,手术指征应从严掌握。

Experince of Treatment of Severe Acute Pancreatitis:Clinical Analysis of 67 Cases

In order to explore non-operative methods and the choice of operative indications in patients with severe acute pancreatitis (SAP), 67 patients with SAP were treated in our hospital from July, 1995 to July, 2000,The results were analysed respectively. All patients were treated in Intensive Care Unit. Non-operative methods included fluid resuscitation, reduction of pancreatic secretion, elimination of inflammatory mediators, supporting function of major viscera,prevention and treatment of infections, restoring function of gastrointestinal tract etc. 29 patients were performed on operation during the treatment, including emergency operation and secondary operation. Using simple operative methods (operation of biliary tract and abdominal drainage, surgical openning of pancreatic panniculus in order to drainadge). The results showed that 12 patients timely conversion to operation, among these cases, biliary tract's disease in 3, pancreatic infections in 6, paralytic ileus in 3, one patient died of DIC and MSOF. 17 patients performed on emergency operation,among these cases, 2 patients died of MSOF. 38 patients were conservatively treated, others were healed except that one suddenly died, total mortality rate were 5.97% .So it can be concluded that the active, effective,comprehensive and non-operative treatment is a basic treatment of SAP, and operative indication should be severely restricted.