重症急性胰腺炎手术指征和手术方式的探讨

目的探讨重症急性胰腺炎的手术指征和手术方式。方法总结１９９１年～１９９７年治疗的重症急性胰腺炎４１例,其中保守治疗２２例,手术治疗１９例。手术方式采取胰腺被膜广泛切开,清除易于清除的坏死组织,胰周多置管引流,腹腔多部位引流。术后行胰周引流管交替灌洗吸引。结果保守治疗重症Ⅰ级１６例,均治愈;重症Ⅱ级６例,治愈３例,死亡３例。手术治疗重症Ⅰ级７例,均治愈;重症Ⅱ级１２例,治愈８例,死亡４例。结论重症急性胰腺炎有感染和并发症者;年龄大于６０岁者;经２４～４８小时保守治疗效果欠佳者,应积极早期手术治疗,其余患者可行保守治疗。手术应尽可能选择创伤小、简便、迅速的方式。同时将手术治疗和保守治疗有机结合,可望提高重症急性胰腺炎的治愈率

The indication and mode of surgery for the treatment of patients with severe acute pancreatitis

OBJECTIVE: To study the indication and mode of surgical management in patients with severe acute pancreatitis (SAP). METHOD: 41 patients with SAP were grouped for conservative treatment or surgical. The main procedures of surgical management were pancreatic debridement, peripancreatic and coeliac drainage, combined with peripancreatic instillation and suction alternatively. RESULT: Conservative treatment was adopted in 22 patients (16 patients in grade I, 6 in grade II), among them 19 recovered, and 3 of grade II died. 19 patients underwent surgical treatment including 7 in grade I, 12 in grade II). 15 patients were cured, 4 patients of grade II died. CONCLUSION: Timely operation is necessary for the patients with infection and complications. Surgical intervention is recommended for patients older than 60 years old. Surgery should be less traumatic, simple and prompt. Surgical or conservative treatment are chosen according to the patients' conditions. The cure rate of SAP can be improved.