急性胰腺炎非感染性胰腺坏死手术时机的探讨  

Operation timing in patients with non-infected pancreatic necrosis of acute pancreatitis

作　　者：夏群[1,2] 胡晔[1,2] 孙春磊[1,2] 

机构地区：[1]安徽医科大学附属省立医院 [2]安徽省立医院综合外科,合肥230001

出　　处：《中国临床保健杂志》2013年第6期628-630,共3页Chinese Journal of Clinical Healthcare

摘　　要：目的探讨急性重症胰腺炎非感染性胰腺坏死手术时机。方法对62例非感染性坏死性胰腺炎进行临床和CT评估以决定手术指征,根据手术发现对手术治疗的时机进行评估分析。结果 9例患者发病2周内手术治疗。49例发病3～4周后手术治疗,其中3例有粘连性或压迫性消化道梗阻;10例发生感染,发生率为20.4%;5例术后死亡,病死率为10.2%。4周后手术患者感染率发生率75%(3/4),2例死亡,病死率50%。结论应对急性胰腺炎非感染性胰腺坏死患者进行动态CT评估,对于坏死大于6 cm、有早期感染表现、有消化道压迫梗阻症状的患者,应行手术治疗,手术时机宜在发病后3～4周。Objective To discuss the choose of operation timing in patient with non-infected pancreatic nec-rosis of acute pancreatitis.Method The indiction for operation was decided according to results of Computer-tomo-graphy evaluation in 62 patients with non-infected necrotic pancreatitis,and operation timing was analyzed according to findings of operation.Results There were 9 and 49 patients with preoperative non-infected pancreatic necrosis re-ceived surgical treatment in 2 weeks and 3 or 4 weeks after onset of illness,respectively.Of the 49 cases,adhesive or oppressive obstruction of the digestive tract was observed in 3 patients,and 5 cases were dead post-operatively,fatality rate was 10.2 percent.The 4 cases were operated after 4 weeks,the rate of infection was 75 percent(3 /4),2 cases were dead post-operatively,fatality rate was 50 percent.Conclusions In patients with non-infected pancreatic necro-sis of acute pancreatitis,whether or not the necrotic pancreas tissue resection should depend on regular CT evaluation;surgical intervention should be considered for patients whose erosions are larger than 6 cm,early infection,and oppres-sive or obstructive symptoms of the digestive tract.The reasonable operation timing is 3 or 4 weeks after the onset of illness.

关 键 词：胰腺切除术 胰腺炎 急性坏死性 外科手术 选择性 

分 类 号：R657.51[医药卫生—外科学]