急性胆源性胰腺炎75例的外科诊治

目的：探讨急性胆源性胰腺炎的外科治疗方法。方法回顾性分析收治的75例急性胆源性胰腺炎患者的临床资料，依据 APACHE 一Ⅱ评分及胆道有无梗阻分为轻型非梗阻型（54例）、重症非梗阻型（6例）、轻型梗阻型（10例）和重症梗阻型（5例）。非梗阻型先采用保守治疗，病情缓解后实施延期或择期手术。轻型梗阻型应在严密监测下积极保守治疗24～72 h，病情无好转，及时手术。重症梗阻型在保守治疗的基础上应早期手术解除胆道梗阻。结果非胆道梗阻型61例全部经非手术治疗后病情缓解，41例延期或择期手术，术后恢复顺利。胆道梗阻型患者急诊及延期手术治疗15例，其中2例重症患者术后死亡。结论在治疗急性胆源性胰腺炎时，应对患者病情作出综合评估，注意区分胆道有无梗阻，轻型患者首先保守治疗，重症患者应采用非手术治疗与个体化治疗相结合的处理原则。

The diagnosis and surgical treatment of 75 cases with acute biliary pancreatitis

Objective：To investigate the diagnosis and surgical treatment methods for acute biliary pancreatitis. Meth-ods：The clinical data of 75 patients with acute biliary pancreatitis were retrospectively analyzed. According to the score of APACHE - Ⅱ and the with or without biliary obstruction,there were 54 light no - obstructive cases,6 severe non - ob-structive cases,10 light obstructive cases,and 5 severe obstructive cases. The patients with no - obstruction were treated with conservative methods. After the remission,the patients were implement extension or undergone surgery. Patients of slight obstruction should be conservatively treated for 24 to 72 h under carefully monitoring. If there is no improvement,the patients need for timely surgery. While patients with severe obstruction should be treated with surgery early on the basis of conservative treatment. Results：Patients of no - obstruction（n = 61）were remission after treated with surgery,and 41 ca-ses recovered smoothly after implement extension. Patients with biliary obstruction and extension of emergency surgery 15 cases,in which 2 cases were died after surgery. Conclusions：All patients should be evaluated for their conditions with or without obstruction for acute biliary pancreatitis. The milder cases should be treated with conservative methods,while serve patients should be treated with combination of no - surgery and personalized therapy.