重症急性胰腺炎非手术治疗方法的探讨  

How to Choose the Operative or Non-operative Treatment of Severe Acute Pancreatitis

作　　者：朱斌[1] 孙家邦[1] 周继盛[1] 杨磊[1] 陈宏[1] 李非[1] 贾建国[1] 

机构地区：[1]首都医科大学宣武医院普外科

出　　处：《首都医科大学学报》2000年第4期314-317,共4页Journal of Capital Medical University

基　　金：北京市卫生局重点学科课题

摘　　要：为探讨重症急性胰腺炎 (SAP)的非手术治疗措施及中转手术的时机。对 2 2 3例SAP患者均先行包括重要脏器功能的支持、防治感染及促进胃肠功能恢复等非手术综合治疗 ,以后根据有无胰腺感染等并发症决定是否中转手术。结果 :前期组 ( 1 990～ 1 994年 ) 97例 ,患者一经诊断胰腺感染即手术治疗 ,病死率为 1 1 .3% ;近期组 ( 1 995～1 999年 ) 1 2 6例 ,选择性延期手术 ,将胰腺感染局限作为手术时机 ,病死率为 5.6%。全部患者非手术治疗过程中因胰腺感染中转手术 2 3例 ,其中胰腺感染局限者的手术病死率 ( 7.7% )显著低于感染未局限者 ( 50 % ) (P <0 .0 5)。结果提示 ,SAP应以积极、有效、综合的非手术治疗为主 。To explore nonoperative methods and the opportunity of operative in patients with severe acute pancreatitis (SAP), 223 patients with SAP were treated in our ICU from 1990 to 1999. Non operative methods included fluid resuscitation , reduction of pancreatic secretion, elimination of inflammation mediators, supportive measures and close supervision, nutritional support , prevention and treatment of infections etc. Indication for operation in patients was pancreatic infection from 1990 to 1994.Aggressive debridement with placement of several drains into lesser sac for the purpose of continuous lavage was performed on the patient of the infectious pancreatic necrosis or fluid collection. The drainage of pancreatic abscess or localized infection with debridement of necrotic tissues was adopted from 1995 to 1999. Twenty three patients underwent operations due to pancreatic infection during the treatment. The postoperative mortality rate of pancreatic abscess or localized infection was lower than that of infectious pancreatic necrosis or fluid collection. Active ,effective and comprehensive non operative treatment is the basic treatment of SAP. The operation of pancreatic abscess or localized infection is more effective than that of unlocalized pancreatic infection.

关 键 词：胰腺炎 感染 综合疗法 

分 类 号：R657.51[医药卫生—外科学]