27例胆源性胰腺炎的诊治分析

目的探讨急性胆源性胰腺炎(Acute biliary pancreatitis，ABP)的诊断和治疗方法。方法回顾性分析我院2000年1月-2005年1月收治的27例ABP的临床资料。结果轻型非梗阻型8例经非手术治疗治愈，并在2～4周内行胆囊切除术；梗阻型15例，8例转为非梗阻型经非手术治愈，2～4周时手术，单纯胆囊切除5例，胆囊切除并胆总管切开取石T管引流3例；7例梗阻不能解除，急诊手术胆囊切除并胆总管切开深查T管减压引流、胰腺被膜切开多管灌洗引流。全部病例均治愈。重型非梗阻型2例，非手术治疗1例，早期开腹手术1例(死于腹腔及后腹膜感染合并霉菌感染致MSOF)；梗阻型2例，均早期开腹手术胆囊切除、胆总管探查、胰腺被膜切开多管灌洗引流，痊愈。结论轻型ABP早期应以非手术治疗为主，综合治疗愈后，应在同一住院期间手术去除胆道病因以防复发。重症ABP慎行早期手术，预防并及时处理并发症是降低ABP病死率的关键。

Experience of diagnosis and treatment of 27 cases of biliary pancreatitis

Objective To research the diagnosis and treatment of acute biliary panceatitis(ABP). Methods The clinical data of 27 patients with ABP treated in our hospital were retrospectively analyzed. Results Mild type: 8 cases of non-obstruction were treated non-operatively and were given cholecystectomy after 2-4 weeks. Among the 15 cases of obstruction, 8 cases were treaed non-operatively and delayed surgical treatment after 2-4 weeks; 7 cases were translated to severe type, which for early emergency operation: cholecystectomy, T-tube drainage and open the pancreatic envelope. Severe type: 2 cases of non-obstruction, one case was treated non-operaticvely and one case receiving poeration was died of multiple organ failure. Among the 2 cases of obstruction for early emergency operation get well. Conclusions Slight ABP should treatment with conservative procedure at first and then postponent operation to wipe off bile duct obstruction pathogeny were performed at the same hospitalization. Eight ABP should be cautious to poeration early. Prevention and treatment of complications was the key to reduce the mortality of ABP.