重症急性胰腺炎外科干预的时机及疗效分析  

Timing and efficacy of surgical intervention for severe acute pancreatitis

作　　者：杨瑾[1] 邵钦树[2] 徐继[1] 俞晓军[1] 徐园[1] 陶厚权[1] 姚海波[1] 

机构地区：[1]浙江省人民医院普外科,杭州310014 [2]浙江省人民医院胃肠外科,杭州310014

出　　处：《中华医学杂志》2013年第46期3691-3693,共3页National Medical Journal of China

摘　　要：目的 探讨重症急性胰腺炎（SAP）外科治疗的适应证、二预时机及方式.方法 回顾性分析了浙江省人民医院白2007年1月至2013年1月收治的1 15例SAP患者的临床资料.结果 外科治疗组62例,保守治疗组53例,治愈率和病死率分别为87.1％和84.9％ （P ＞0.05）、9.68％和9.43％ （P ＞0.05）.外科治疗组行早期干预（＜2周）25例,延期干预组（≥2周）37例,平均干预时间分别为（7.5±3.3）d和（23.9±8.5）d（P＜0.05）.两组再次外科干预率分别为64.0％和37.8％（P＜0.05）,病死率分别为16.0％和5.4％（P＞0.05）.结论 外科治疗在SAP的治疗中仍有着举足轻重的地位.干预方式应根据患者具体病情采取个体化治疗方案.对于胰腺坏死伴感染患者,如其一般情况尚可,应尽可能将手术时间延至病后3～4周.Objective To explore the indications,timing and approaches of surgical interventions for severe acute pancreatitis （SAP）.Methods A retrospective study was performed for 115 hospitalized SAP patients from 2007 to 2013.Results Among them,62 underwent surgery and another 53 were treated conservatively.The curative and mortality rates of surgical intervention and non-operation groups were 87.1% vs 84.9% （P 〉 0.05） and 9.68% vs 9.43% （P 〉 0.05） respectively.Twenty-five patients received early surgical intervention （〈 2 week） and another 37 delayed surgical intervention.The interval from diagnosis to surgical intervention of two groups were 7.5-± 3.3 and 23.9 ±_ 8.5 days respectively.The mortality rates of early and delayed surgical groups were 16.0% and 5.4% respectively （P 〉 0.05）.Conclusions Individualized comprehensive therapy should be offered in the treatment of SAP.Timing of surgery for those with pancreatic necrosis and infection should be delayed to 3-4 weeks later until their general conditions permit.

关 键 词：胰腺炎 急性坏死性 外科手术 

分 类 号：R657.5[医药卫生—外科学]