重症急性胰腺炎感染的外科处理

收集79例重症急性胰腺炎（ANP）继发感染的临床资料，以探讨ANP继发感染的外科治疗。结果：79例手术时间平均为发病后6.5d，手术方式为坏死组织清除加小网膜持续灌洗。此外，其中14例进行了胰尾及脾切除，3例次全胰切除，1例全胰切除，2例肠切除，1例部分肝切除，27例胆囊造瘘。另胆囊造瘘加胆总管切开引流13例，腹膜后引流21例，所有病人的坏死胰腺组织，腹腔穿刺液，腹腔灌洗液及血液细菌培养均为阳性，13例并发霉菌感染，死亡率为35．4％，提示：ANP继发感染一旦确诊，经监护24h病情无好转者应积极手术。

Surgical Management of Secondary Infections in Acute Necrotizing Pancreatitis

Clinical records of 79 patients with acute necrotizing pancreatitis(ANP) have been collected to study the surgical management of secondary infections.Surgical treatment was performed by an average of 6.5 days after the onset of ANP.Operative management consisted of necrosectomy of all the affected area,combined with continuous irrigation of lesser omentam and suction drainage.Fourteen patients were subjected to resection of the tail of pancreas and splenectomy; 3 had subtotal pancreatectomy; 1 total pancreatectomy,2 enterectomy; 1 partial hepatectomy; 27 cholecystostomy.13 patients had cholecystostomy plus choledochostomy and drainage and 21 had retroperitoneal drainage.Cultures of necrotizing panereatic tissue,peritoneal aspirates,peritoneal irrigates and blood from the patients revealed positive bacteriological findings and 13 patients were complicated with candidal infections.The mortality rate was 35.4%.Once ANP with secondary infection is diagnosed and the condition of illness without improvement in 24 h under monitor,vigorous surgical management should be made.