重症急性胰腺炎外科治疗策略及临床转归变化的分析及其再认识  

A retrospective analysis for surgical strategy and prognosis of severe acute pancreatitis

作　　者：昌毓穗[1] 刘季春[1] 傅华群[2] 邹书兵[2] 喻本桐[1] 

机构地区：[1]南昌大学第一附属医院外科,江西南昌330006 [2]南昌大学第二附属医院外科

出　　处：《上海医学》2012年第11期927-930,共4页Shanghai Medical Journal

摘　　要：目的探讨重症急性胰腺炎(SAP)外科治疗策略及临床转归的变化。方法回顾性分析南昌大学第二附属医院1981―2010年216例SAP患者的临床资料,总结SAP治疗策略的转变并分析其产生变化的原因。结果不同时间段患者的性别构成、年龄、病因及自发病至入院的时间的差异均无统计学意义(P值均>0.05)。1991―2000年时间段患者自发病至首次手术的时间显著长于1981-1990年时间段(P<0.05);2001―2010年时间段显著长于1981-1990年时间段(P<0.05),而显著短于1991―2000年时间段(P<0.05)。1991―2000年时间段患者的手术干预率显著低于1981-1990年时间段(P<0.05);2001―2010年时间段的显著低于1981-1990年时间段(P<0.05),而显著高于1991―2000年时间段(P<0.05)。2001―2010年时间段的连续静脉血液滤过、微创穿刺置管引流和早期肠内营养的使用率均显著高于前2个时间段(P值均<0.05),全肠外营养平均使用时间较前2个时间段显著缩短(P值均<0.05)。2001―2010年时间段多器官功能不全综合征的发生率、病死率均显著低于前2个时间段(P值均<0.05),住院时间亦较前2个时间段显著缩短(P值均<0.05)。结论近半个世纪以来,SAP的外科治疗经历了以手术治疗为主、以非手术治疗为主及综合治疗体系的3个不同策略阶段,不同阶段的临床转归发生明显变化。认识的深化及治疗技术进步在SAP的治疗策略变化中起了至关重要的作用。Objective To investigate the change of surgical treatment and the difference of prognosis in patients with severe acute pancreatitis in the past 30 years. Methods The clinical data of 216 patients with severe acute pancreatitis in the Second Affiliated Hospital of Nanchang University between 1981 and 2010 were retrospectively analyzed. The treatment therapy for severe acute pancreatitis was summarized. Results There were no significant differences in sex, age, etiology or the interval from initiation of disease to hospital admission between different periods （1981 - 1990, 1991 -2000 and 2001 -2010, all P〈0.05）. The interval from initiation of disease to operation was the shortest during the period of 1981 - 1990 and longest during the period of 1991 - 2000 （all P〈0.05）. The frequency of surgery is the highest during the period of 1981 -- 1990 and lowest during the period of 1991 -2000 （all P〈0.05）. Continuous venous hemofiltration, minimally invasive puncture and drainage, and early enteral nutrition were more frequently used in the period of 2001 -2010 than ever before. As compared with the period of 1981 - 1990 and 1991 - 2000, total parenteral nutrition and hospital stay were significantly shortened, and the incidence of organ failure and multiple organ dysfunction syndrome and in-hospital mortality were significantly decreased during the period of 2001 - 2010 （all P〈0.05）. Conclusion The treatment for severe acute pancreatitis has exeperienced the surgical regime, non-surgical regime and multi-disciplinary treatment regime from 1981 to 2010 in China, and the prognosis of patients is significantly improved. It contributes greatly to the improvement of clinical technique and elucidation of mechanism.

关 键 词：重症急性胰腺炎 外科治疗 营养支持 死亡率 

分 类 号：R657.51[医药卫生—外科学]