重症急性胰腺炎感染期手术时机选择的临床研究  

Clinical study on the timing of surgical intervention in the infection phase of severe acute pancreatitis

作　　者：侯振宇[1] 崔乃强[2] 张鸿涛[2] 张静[3] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市南开医院外二科,天津300100 [3]天津武警医学院附属医院普通外科,天津300162

出　　处：《中国普通外科杂志》2011年第9期917-920,共4页China Journal of General Surgery

摘　　要：目的探讨重症急性胰腺炎（SAP）感染期手术时机的选择。方法回顾性分析2003年1月—2011年1月南开医院收治的88例SAP进入感染期并行手术的患者临床资料,根据发病至手术时的时间分为A组（发病1~2周）,B组（发病3~4周）和C组（发病5周以上）。比较各组手术时急性生理与慢性健康（APACHE-Ⅱ）评分、血C反应蛋白（C-reaction protein,CRP）水平、病死率、再手术次数及术后并发症等情况。结果 APACHE-Ⅱ评分和血C反应蛋白水平B组[4.74±0.82,（84.81±4.65）U/L]明显低于A组[9.14±0.33,（103.40±4.40）U/L]及C组[8.69±0.30,（122.40±3.86）U/L]（均P〈0.01）;手术后病死率、再手术次数及术后并发症B组（6%,27.66%,23.40%）比A组（12.03%,90.32%,51.61%）及C组（40%,80%,80%）均明显减少（均P〈0.01）。结论重症急性胰腺炎感染期最佳手术时机是发病后的3~4周,该时期手术术后并发症少,再次手术机率和死亡率降低。Objective To investigate the timing of the surgical intervention in the infection phase of severe acute pancreatitis（SAP）.Methods The clinical data of 88 SAP patients admitted in Nankai hospital,who underwent surgical treatment in the infection phase,from January 2003 to January 2011 were retrospectively analyzed.According to the time span from the onset of SAP to receiving surgery,the patients were divided into group A（1 week to 2 weeks after onset）,group B（3 to 4 weeks after onset） and group C（more than 5 weeks after onset）.The score of acute physiology and chronic health evaluation（APACHE-Ⅱ）,C-reactive protein level,reoperation rate,fatality and postoperative complications,etc.were compared among the groups.Results The APACHE-Ⅱ score and blood C-reactive protein level of group B [4.74±0.82,（84.81±4.65）U/L] were significantly decreased compared with group A [9.14±0.33,（103.40±4.40）U/L] and group C [8.69±0.30,（122.40±3.86）U/L],respectively（both P0.01）.The fatality,reoperation rate and postoperative complications of group B（6%,27.66%,23.40%） were significantly lower than those of the group A（12.03%,90.32%,51.61%） and group C（40%,80%,80%）,respectively.（all P0.01）.Conclusions The optimal timing of surgery for SAP in infection phase is 3 to 4 weeks after the onset of SAP.At that time,surgical intervention results in less postoperative complications,lower reoperation rate,and lower mortality.

关 键 词：胰腺炎 急性坏死性/外科学 感染期 手术时机 

分 类 号：R657.5[医药卫生—外科学]