胆源性复发性胰腺炎87例的临床分析

目的 总结胆源性复发性胰腺炎的诊治体会，以利进一步提高诊治水平。方法 对87例胆源性复发性胰腺炎的临床资料进行回顾性分析。结果 87例占同期胆源性胰腺炎的22．9％(87／380)，二次发病者48例(水肿型4l例，重型7例。其中死亡1例)，三次以上发病者39例(水肿型25例，重型14例．其中死亡4例)。复发间期以3周内12例(13．8％)，6周内37例(42．5％)，8周内32例(36．8％)为主。约90％的有诱发因素。本组 手术治疗58例，死亡2例(3．4％)。手术时间为保守治疗(水肿型)炎症控制后(3—4周)，方式以胆囊切除为主，若有胆总管结石则探查取石，T管引流，以及假性胰腺囊肿—空肠Y式吻合等．效果优良。保守治疗29例，死亡3例(10．3％)。结论 胆源性复发性胰腺炎的诊断应分型、分级。经保守治疗．使胰腺炎症控制后3周左右，及时手术，可有效减少其复发。

Clinical analysis of 87 cases of recurrent biliogenic pancreatitis

Objective To summarize the experience in diagnosis and treatment of recurrent biliogenic pancreatitis and to improve the therapeutic level.Methods 87 cases of recurrent biliogenic pancreatitis were analyzed on clinical materials retrospectively.Results 87 cases constituted 22.9% in the total 380 cases of biliogenic pancreatitis at the same time. 48 cases were bi diseased, of whom, 41 cases were edematous, 7 cases were serious, 1 case was dead ; 39 cases were tri diseased and repeatedly diseased, of whom, 25 cases were edematous,14 cases were serious, 4 cases were dead . 12 cases (13.8%) recurrent intervals were within 3 weeks, 37 cases (42.5%) within 6 weeks, 32 cases (36.8%) within 8 weeks. About 90% patients had the revulsive factors. In this group, 58 cases received surgical treatment, 2 of them were dead (3.4%). Operation time was after conservative treatment and inflammation control (3 to 4 weeks), cholecystectomy was the main method, choledochus exploration would be performed if the calculus was found, T tube drainage and Y type cysto jejunostomy of pancreas, etc. This was very effective. 29 cases received conservative treatment, 3 of them were dead (10.3%). Conclusion The diagnosis of recurrent biliogenic pancreatitis would be distinguished among differing cases and differing stages for treatment. After conservative treatment, controling the symptom of pancreatitis for about 3 weeks, cholecystectomy should be performed in time . The recurrence may be reduced effectively.