104例胆源性急性胰腺炎手术治疗时机探讨

目的 探讨胆源性急性胰腺炎的诊断和手术时机。方法 2004年6月至2006年12月间收治胆源性急性胰腺炎104例，根据有无胆道梗阻及轻重程度分为4类：轻症非梗阻型、轻症梗阻型、重症非梗阻型、重症梗阻型，对其临床治疗结果 进行回顾性分析和总结。结果轻症非梗阻型35例．轻症梗阻型22例、重症非梗阻型20例、重症梗阻型27例。轻症非梗阻型或轻症梗阻型胰腺炎早期手术与延期手术在并发症的发生率、平均住院日、死亡率上差异无统计学意义（P〉0．05）；对重症非梗阻型和重症梗阻型胰腺炎而言，早期手术并发症的发生率高、平均住院日长，与延期手术比较，差异有统计学意义（P〈0．05），但重症梗阻型胰腺炎早期手术死亡率明显低于延期手术（P〈0．05）。结论 手术时机对胆源性急性胰腺炎患者的预后有重大影响，早期宜行保守治疗，根据患者个体情况选择适当时机进行手术治疗是减少并发症、提高治愈率的关键。

Analysis of operative opportunity of biliary acute pancretitis in 104 cases

Objective To investigate the diagnosis and operative opportunity of biliary acute pancreatitis. Methods From .lune 2004 to December 2006, 104 cases of biliary acute pancreatitis admitted to our hospital were studied. According to obstruction or unobstruction of biliary tract and severity of acute pancreatisis, these cases were divided into four types： mild acute obstructive or unobstructive biliary pancreatitis and severe acute obstructive or unobstructive biliary pancreatitis. Results Of them, 35 cases were diagnosed mild acute unobstructive biliary pancreatitis, 22 cases mild acute obstructive biliary pancreatitis, 20 cases severe acute unobstructive biliary pancreatitis and 27 cases severe acute obstructive biliary pancreatitis. There was no statistical difference in the complication, average hospitalized day and mortality between early operation group and lately operation group （P〉0.05） in the mild acute unobstructive biliary pancreatitis or obstructive biliary pancreatitis. There was significantly statistical difference in the complication and average hospital day between early operation group and lately operation group （P〈0.05） in the severe acute unobstructive biliary pancreatitis or obstructive biliary pancreatitis, but there was lower mortality in the early operative group with severe acute obstructive pancreatitis （P〈0.05）. Conclusion Operative opportunity is very important for the prognosis of biliary acute pancreatitis. Reasonable conservative treatment can be adopted for the early phase of biliary acute pancreatitis. The key to reduce complication and improve cure rate is to determine the proper operative opportunity according to the individual patient＇s condition.