不同原因重症胰腺炎的预后相关因素分析  

PROGNOSIS AND CORRELATIVE FACTORS IN SEVERE ACUTE PANCREATITIS WITH DIFFERENT ETIOLOGY

作　　者：王俊刚[1] 王金龙[1] 南禾[1] 刘俊斌[1] 何涛[1] 金志宏[1] 

机构地区：[1]内蒙古医学院第一附属医院普外科,呼和浩特010050

出　　处：《肝胆外科杂志》1998年第6期332-334,共3页Journal of Hepatobiliary Surgery

摘　　要：目的探讨两种不同原因的重症胰腺炎（SAP）预后有关的因素及手术时机的选择。方法对收治的106例SAP患者的手术、非手术治疗以及病死率进行对照及回顾分析。结果①全组病死率33．9％。其中胆源性组为21．5％，非胆源性组为45．5％。②随手术距入院时间延长病死率明显降低，入院后12小时内急诊手术者病死率明显高于其他时间组（P＜0．05）。③随胰腺坏死程度和胰外器官受累数的增加，病死率显著增加（P＜0．01）。④休克、胰腺坏死、感染、Binder合并症评分及MOF的相关病死率分别为58．0％、96．1％、52．5％、78．5％和68．3％（P均＜0．05）。结论SAP的胰坏死程度、全身状况、休克、感染、胰外器官受累数、MOF及手术时机是影响其预后的重要因素。而一但发病，则与其原始病因无关。治疗及手术时机的选择应尽量避免在发病后1～7天内手术，尤其是入院后急诊手术。强调在术前给予至少24小时的有效支持治疗，以改善机体内环境。Objective To investigate the prognosis and correlative factors in biliary and non-biliary severe acute pancreatitis(SAP), 106 cases of SAP were analysed retrospectively. Methods 106 cases of SAP admitted from 1984 to 1997 were divided in-to operative group and non-operative group,and the mortalities and correlative factors were analysed retrospectively. Result ①The total mortality of two groups was 33. 9%,with the biliary SAP group 21. 5 % and non-biliary SAP group 45. 5%. ②The laterthe operations were performed after admission,the lower of the mortality. The emergency operations performed within 12 hours after admission were related with a higher mortality. ③When the involved extrapancreatic organs were increased,the mortality washigher (P<O. 01). ④The mortality of correlation with shock,pancreatic necrosis,infection and MOF were 58. 0%, 96. 1%,52. 5%and 68. 3% respectively. Conclusion The factors of influence on SAP mortality included degree of pancreatic necrosis,general condition, shock,infection,involved extrapancreatic organs,MOF and operative timing. At the onset of the disease,the mortality of SAPhad nothhing to do with the etiology. The emergency operation performed within one week after the disease onset should beavoided,and 24 hours of the effective supporting treatment before operation was important. The surgical therapy should be aimed atthe debridement of necrotic tissues,full drainage and elimination etiology.

关 键 词：胰腺炎 外科手术 预后 相关因素 

分 类 号：R657.510.1[医药卫生—外科学]