区域动脉灌注治疗重症急性胰腺炎的适应证探讨  

Study on indication of regional arterial infusion for the treatmnet of severe acute pancreatitis

作　　者：钱琼信[1] 孙洪伟[1] 金约朋[1] 朱千东[1] 朱椰凡[1] 周蒙滔[1] 张启瑜[1] 

机构地区：[1]温州医学院第一附属医院肝胆胰外科,浙江温州325000

出　　处：《肝胆胰外科杂志》2011年第4期290-292,共3页Journal of Hepatopancreatobiliary Surgery

基　　金：浙江省医药卫生重点科研项目(2003ZD010);温州市科技局项目(Y2004A003)

摘　　要：目的探讨早期区域动脉灌注治疗重症急性胰腺炎的适应证。方法分析各种类型的重症急性胰腺炎患者的区域动脉灌注治疗的疗效。结果①45例重症急性胰腺炎患者采用区域动脉灌注治疗,治愈43例,治愈率95.6%。②10例入院时合并有胰外脏器功能障碍的患者采用区域动脉灌注治疗,治愈9例,治愈率90%。③13例在治疗过程中继发感染的病例采用区域动脉灌注抗生素治疗,治愈12例,治愈率为92.3%。④2例腹腔室间隔综合征患者采用早期手术联合区域动脉灌注治疗,1例治愈,1例病死。结论①适应早期非手术治疗者可采用区域动脉灌注治疗。②早期未局限化的胰腺坏死继发感染病例可采用区域动脉灌注抗生素治疗。③排除腹腔室间隔综合征后诊断"暴发性胰腺炎"者也是区域动脉灌注的适应证。④需要早期手术的危重患者如腹腔室间隔综合征可联合区域动脉灌注治疗,以提高疗效。Objective To study the indication of regional arterial infusion（RAI） for the treatment of severe acute pancreatitis（SAP）.Methods The therapeutic effectiveness of all types of cases diagnosed as SAP treated with RAI was analyzed.Results ①Forty-five cases with SAP were treated with RAI,of them,forty-three were cured.The cure rate was 95.6%.②Ten cases complicated with organ dysfunction on admission were treated with RAI,and nine cases were cured.The cure rate was 90%.？③Thirteen cases complicated with secondary infection during the course of treatment.They were treated with RAI,twelve cases were cured.The cure rate was 92.3%.④Two cases complicated with abdominal compartment syndrome（ACS） were treated with operation combined with RAI on early stage.One case was cured,the other one died.Conclusion ①The cases with severe acute pancreatitis treated by non-operation method on early stage can be treated with RAI.②When the pancreatic secondary infectious loci were not localized on early stage,the cases with secondary infection can be treated with RAI with antibiotic.③The cases diagnosed as fulminating severe acute pancreatitis who do not belong to ACS may be the indication of RAI.④If the critical cases such as ACS should be operated on early stage,RAI may combine with RAI to improve its therapeutic effect.

关 键 词：重症急性胰腺炎 动脉内灌注 治疗 适应证 

分 类 号：R657.51[医药卫生—外科学]