胆源性胰腺炎手术时机的探讨

目的探讨胆源性胰腺炎（ＧＰ）的手术时机。方法采用统计学方法分析了５３例ＧＰ的临床资料。结果早期手术组（入院４８小时内）及延期手术组（入院４８小时后）并发症发生率分别为２９．２０％和３．５０％（Ｐ＜０．０５）;死亡率分别为８．３０％和０（Ｐ＜０．０５）。ＡＰＡＣＨＥ－Ⅱ记分≤８的轻型ＧＰ死亡率与手术时机无关,但早期手术组的并发症发生率（１１．１０％）及胆总管探查率（９１．７０％）明显高于延期手术组（Ｐ＜０．０５）。ＡＰＡＣＨＥ－Ⅱ记分＞８的重型ＧＰ并发症发生率及死亡率与手术时机有关,即早期手术组明显高于延期手术组。结论轻型ＧＰ应待急性发作缓解后延期手术;重型ＧＰ应采用延期与个体化相结合的处理原则。

Timing of surgical treatment for gallstone pancreatitis

OBJECTIVE: To evaluate the timing of surgery in the treatment of gallstone pancreatitis (GP). METHOD: The records of 53 patients with GP were retrospectively analysed. RESULT: The morbidity and mortality of early surgical treatment (less than 48 hours after admission) were 29.20% and 9.30%, respectively, in contrast to 3.50% and 0 in patients who underwent delayed surgical treatment (more than 48 hours after admission) (P < 0.05). In mild gallstone pancreatitis (APACHE-II 8), the timing of surgery was related to the morbidity and mortality, namely, they were higher in early surgery than in delayed surgery. CONCLUSION: We suggest delayed surgical treatment for mild gallstone pancreatitis, and delayed and selective surgery for severe gallstone pancreatitis.