急性坏死性胰腺炎治疗的临床分析

目的:对急性坏死性胰腺炎(ANP)的内、外科治疗进行临床分析。方法:对58例ANP进行了分析,其中非手术组15例,手术组43例。在治疗的以下几个方面进行了对比:在非手术组中是否使用胰液/胰酶抑制剂;在手术组中72小时内和72小时后手术;在抗生素治疗上,二联用药(头孢唑啉 甲硝唑)与多联用药。结果:非手术组中用过胰液分泌抑制剂或胰酶抑制剂者死亡率为12、5％,显著低于未用过胰液分泌抑制剂或胰酶抑制剂者(71.4％,P<0.05);手术组中72小时以内手术者死亡率为36.7％,显著低于72小时以上者(84.6％,P<0.01);抗生素治疗方面,二联用药(头孢唑啉 甲硝唑)与广谱、多联用药的死亡率无显著差异(P>0.05)。结论:由于胰液/胰酶抑制剂能降低轻症ANP的死亡率,轻症病人应积极采用胰液/胰酶抑制剂为主的综合治疗,重症病人应早期手术;而在抗生素治疗上,除非有严重感染,一般仅需二联用药,无需多种广谱抗生素联用。

Acute Necrotizing Pancreatitis: Evaluation of Clinical Managements

Aims: To evaluate medical and surgical managements of acute necrotizing pancreatitis (ANP). Methods: Fifty eight cases of ANP were analyzed. The mortalities of patients with different managements were compared, including treated with and without pancreatic secretion inhibitor or enzyme inhibitor in the non-operation group; taken operation within 72h and after 72h in the operation group; bitherapy (cefazoline metronibazde) and multitherapy of antibiotics in all cases. Results: The mortalities of patients treated with pancreatic secretion inhibitor or enzyme in the non-operation group was 12.5%, which was significant lower than that not treated with these agents (71.4%, P<0. 05). The mortalities of patients taken operation within 72h was 36.7% , which was significant lower than that after 72h (84.6%, P<0.01). As to antibiotic treatment, the mortality of patients with bitherapy and multi-therapy was 61.5%, 44.4%, respectively(P >0. 05). Conclutions; Pancreatic secretion inhibitor or enzyme inhibitor, which can decrease the mortality of mild ANP, are supposed to be given for these patients. Early operation should be taken for severe ANP. Unless severe infection, bitherapy of antibiotics is enough, while multitherapy is not needed.