1033例重症急性胰腺炎治疗经验总结

目的 总结重症急性胰腺炎的治疗经验.方法 1997年1月至2009年3月,南京军区南京总医院全军普通外科研究所共收治重症急性胰腺炎患者1033例,男性622例,女性411例;年龄13～98岁,平均51岁.APACHEⅡ评分(12.0±4.3)分.所有患者的治疗均由ICU、外科、内镜、影像和血液净化等专业医师组成的治疗小组完成.患者早期均在ICU内进行监测治疗,其中机械通气365例,气管切开218例,行床旁持续大流量血液滤过159例,行鼻胆引流179例,早期肠内营养513例,CT引导下经皮胰周穿刺引流477例次,因胰周坏死感染行胰周坏死组织清除引流术438例.结果 1033例患者中,975例治愈出院(94.4%),38例患者死亡,其中手术患者病死率7.1%(31/438).结论 多专业医生组成的治疗小组可能更有利于重症急性胰腺炎的治疗.

Treatment experience of severe acute pancreatitis on 1033 cases

Objective To summary the treatment experience of severe acute pancreatitis (SAP).Methods From January 1997 to March 2009, a total of 1033 patients suffered SAP were admitted with a mean APACHE Ⅱ score 12.0 ±4.3. There were 622 males and 411 females, aged from 13 to 98 years old. All patients were cared by the muhidisciplinary team with intensivist, endoscopists, gastroenterologists,radiologist,nephrologist and surgeons. Patients treated in SICU in the early phase of the disease. In these 1033 patients,365 cases received mechanical ventilation,218 with tracheotomy, 159 cases received high-volume continuous venovenous hemofiltration (CVVH), 179 received nasobiliary drainage, 513 were treated with early enteral nutrition. CT-guided percutaneous catheter drainge for peripancreatic fluid collection was pefromed for 477 times and 438 patients received surgical debridement for infected pancreatic necrosis. Results In all these 1033 cases,975 patients(94.4%) survived,and 38 patients died(3.7%).The mortality of patients who received surgical debridement for infected pancreatic necrosis was 7.1%(31/438). Conclusion The muti-discipline management of severe acute pancreatitis can remarkably improve the prognosis of patients.