重症急性胰腺炎外科手术时机的探讨  

Discussion on the timing of surgery for severe acute pancreatitis

作　　者：李洪[1] 姜丰星 王建东[1] 信明军[1] 于江[1] 葛忠[1] LI Hong;JIANG Feng-xing;WANG Jian-dong;XIN Ming-jun;YU Jiang;GE Zhong(Department of Hepatobiliary Surgery,Qingdao Municipal Hospital,Qingdao,Shandong,266011)

机构地区：[1]青岛市市立医院肝胆外科,山东青岛266011

出　　处：《临床普外科电子杂志》2018年第3期20-23,共4页Journal of General Surgery for Clinicians(Electronic Version)

摘　　要：目的探讨重症急性胰腺炎外科时机。方法本组重症急性胰腺炎(severe acute pancreatitis, SAP)患者103例,其中,Ⅰ型54例,Ⅱ型49例,49例患者在入院当天到1周内施行手术治疗,20例施行蝶形开放引流术,其中2次以上手术清除坏死组织18例,3次手术清除坏死组织者3例。超声或CT引导下的介入治疗29例。结果全组死亡率为12.6%,死亡病例均为Ⅱ型患者。结论早期手术并不能终止SAP的病理进程,反而加重了全身循环和代谢紊乱,增加感染的发生及死亡率,但胆源性SAP以及胰腺周围组织感染需早期手术,通过系统的营养支持以及早期腹腔灌洗能有效治疗SAP急性期内全身中毒反应,使患者存活率显著提高。Objective To investigate the timing of surgery for severe acute pancreatitis.Methods 103 patients with SAP were enrolled.There were 54 patients with typeⅠand 49 patients with typeⅡ.49 patients underwent surgery on the day of admission,and 20 patients underwent surgery which is Butterfl y open drainage.18 cases were treated with more than 2 operations to remove necrotic tissue,and 3 cases were treated with 3 cases of necrotic tissue removal.Interventional therapy under the guidance of B-ultrasound or CT was performed in 29 cases.Results The mortality rate of the whole group was 12.6%,and the death cases were all typeⅡpatients.Conclusion Early surgery can not stop the pathological process of severe acute pancreatitis,but increase the systemic circulation and metabolic disorders,increase the incidence of infection and mortality.but biliary severe acute pancreatitis and tissue infection around the pancreas require early surgery,and we can effectively stop the systemic toxic reaction in the acute phase of SAP by the system Nutritional support and early peritoneal lavage,resulting in a signifi cant increase in patient survival.

关 键 词：重症急性胰腺炎 胆源性胰腺炎 肠内营养 腹腔灌洗 

分 类 号：R657.51[医药卫生—外科学]