重症急性胰腺炎外科综合治疗的经验总结  

Experience of the surgical comprehensive treatment on severe acute pancreatitis

作　　者：孙备[1] 周昊昕[1] 李军[1] 王刚[1] 刘杰武[1] 林枫[1] 李泮泉 赵鸣雁[2] 杨幼林[3] 姜洪池[1] 

机构地区：[1]哈尔滨医科大学附属第一医院胰胆外科,150001 [2]哈尔滨医科大学附属第一医院ICU,150001 [3]哈尔滨医科大学附属第一医院消化内科,150001

出　　处：《中华外科杂志》2010年第18期1383-1386,共4页Chinese Journal of Surgery

基　　金：教育部新世纪优秀人才支持计划资助项目（NCET-07-0248）;黑龙江省杰出青年基金资助项目（JC200717）;黑龙江省科技厅攻关资助项目（GC09C407-2）

摘　　要：目的 总结重症急性胰腺炎（SAP）外科综合治疗的经验.方法 1999年7月至2009年12月共收治SAP患者506例,男性270例,女性236例;年龄16～89岁,平均43岁.慢性健康评估Ⅱ（APACHE Ⅱ）评分（12.8±4.6）分.SAP患者的治疗由胰腺专科医师与多学科组成的SAP治疗小组完成.非手术治疗234例（46.2%）,外科干预治疗272例（53.8%）.结果 506例SAP患者中,445例治愈,52例死亡（早期死亡31例、后期死亡21例）,9例自动出院.总并发症发生率为29.4%（149/506）,病死率为10.3%（52/506）,治愈率为87.9%（445/506）.并发症发生率：非手术组为27.8%（65/234）,外科干预组为30.9%（84/272）（P＞0.05）;病死率：非手术组为9.4%（22/234）,外科干预组为11.0%（30/272）（P＞0.05）;治愈率：非手术组为90.6%（212/234）,外科干预组为85.7%（233/272）（P＞0.05）.结论 APACHEⅡ评分＞10分的患者应入ICU治疗;建立胰腺专科队伍与多学科合作的SAP治疗模式、正确把握外科干预的时机与指征及选择合适的干预方式、重视引流细节,对于SAP预后至关重要.Objective To summary the experience of the surgical comprehensive treatment of severe acute pancreatitis（SAP）. Methods From July 1999 to December 2009,a total of 506 patients suffered SAP were admitted with a mean APACHE Ⅱ score 12. 8 ±4.6. There were 270 male and 236 female,aged from 16 to 89 years,mean age 43 years. SAP patients were treated by the SAP treatment team which consisted of pancreatic specialized and multidisciplinary doctors. Two hundreds and thirty-four cases（46. 2% ）received non-operative treatment and 272 cases（53. 8% ） received surgical intervention. Results In 506 cases,445patients were cured and 52 patients died（31 died in early stage,21 died in later stage） ,9 cases discharged automaticly. The overall incidence of complication, overall mortality and overall curative rate were 29. 4%（ 149/506 ）, 10.3% （52/506） and 87.9% （445/506）, respectively. The incidences of complication in nonoperative group and in surgical intervention group were 27. 8% （65/234） and 30. 9% （84/272） ,respectively （P〉0.05）. The mortality in non-operative group and in surgical intervention group were 9.4% （22/234）and 11.0%（30/272）, respectively（P〉0.05）. The curative rates in non-operative group and in surgical intervention group were 90. 6% （ 212/234 ） and 85.7% （ 233/272 ）, respectively （P〉0.05 ）. Conclusions Patients should be treated in ICU in the early phase of the disease when APACHE Ⅱ score〉10. Pancreatic specialized and multidisciplinary team treatment, appropriate choice of timing, indication and procedure of surgical intervention and details of drainage are vital to the prognosis of SAP.

关 键 词：胰腺炎 治疗 手术时机 治疗方案 

分 类 号：R657.5[医药卫生—外科学]