重症急性胰腺炎的手术指征及手术方法再评估  

A Further Evaluation of Surgical Indications and Approaches for Severe Acute Pancreatitis

作　　者：刘胜利[1] 杨德同[1] 陈峰[1] 王尔慧[1] 高乃荣[1] 陈怀仁[1] 

机构地区：[1]南京铁道医学院附属医院胆胰外科

出　　处：《南京铁道医学院学报》1998年第4期264-266,共3页Journal of Nanjing Railway Medical College

基　　金：江苏省卫生厅重点资助课题

摘　　要：目的：重新评估重症急性胰腺炎（ＳＡＰ）的手术指征和手术方法。资料和方法：将本院１９９２年３月～１９９７年１０月手术治疗的ＳＡＰ患者３４例分成３组：第１组（组１）１２例，手术指征和手术方法与以往相同；第２组（组２）１４例，１０例仅作了胆囊切除；第３组（组３）８例，系中转手术或外院手术后转入病例。结果：组１与组２比较死亡率有显著性差异（Ｐ＜０．０５），并发症记分、住院时间有高度显著性差异（Ｐ＜０．００１）。组２治疗效果明显优于组１，这与组２多数病例仅作了胆囊切除有关。组３因部分病人发病４８ｈ内病情不详未参与比较。结论：ＳＡＰ的手术指征应为：（１）证实有胰腺感染或胰腺脓肿者；（２）经非手术治疗症状不缓解及短期内出现巨大假性囊肿者；（３）需要剖腹探查鉴别者。改善胰周感染或脓肿手术疗效的关键是提高早期诊断水平。对于急症手术时发现为ＳＡＰ者，以仅作单纯切除胆囊为最佳选择。Objective:The aim of this study was to further evaluate the indications and the managements of surgery for the patients with severe acute pancreatitis (SAP).Materials and Methods:Thirty-four patients with SAP had been consecutively operated in our hospital from March 1992 to October 1997. There were 14 men and 20 women aged 28～65 years with the mean age of (49±10) years. The patients were divided into three groups.Group 1 consisted of 12 cases who were admitted between Mar.1992 and Sept.1993, during which the surgical indications and procedures were similar to those before. From then on, the patients entered group 2 (14 cases), of which most received cholecystectomy only (10/14). Group 3 included 8 cases who were operated after a period of conservative treatment or shifted to our hospital with pancreatic abscess after operations. Results:There were significant differences in mortality rate( P <0.05) and highly significant differences in cumulative complication scores and the hospitalization time ( P <0.01) between group 1 and group 2.Group 3 is incomparable with the others because some parameters of it were uncertain within 48 hours after onset.Conclusions:The operative indications for SAP should be:(1) The patient in the presence of pancreatic abscess;(2) The one who fails to conservative treatment or with an unbearable large acute pseudocyst;(3) The one who is in need of differentiation.The sticking point to improve the operative effect for pancreatic abscess is to detect it in early stage. When a patient with SAP is come across at urgent operation, cholecystectomy would only be a perfect choice.

关 键 词：胰腺炎 急性 外科手术 治疗 

分 类 号：R657.510.5[医药卫生—外科学]