重症急性胆源性胰腺炎(SABP)的治疗和手术时机的选择——附118例临床诊疗分析  

THE TREATMENT AND SELECTION OF OPERATIVE TIMING OF SEVERE ACUTE BILIOGENIC PANCREATITIS(SABP)-CALINICAL ANALYSIS OF 118 CASES

作　　者：陈杰[1] 马凤藻[1] 游凯涛[1] 李杰[1] 

机构地区：[1]首都医科大学附属北京朝阳医院普外科,北京100020

出　　处：《肝胆外科杂志》2003年第1期32-35,共4页Journal of Hepatobiliary Surgery

摘　　要：目的　探讨重型急性胆源性胰腺炎的合理治疗方法及手术时机。方法　回顾性分析我院 1980年 1月至 2 0 0 2年2月间诊治的 18例 SABP病例 ,按治疗阶段早期手术组和延期手术组 ,观察两组并发症及治疗效果。结果　早期手术组 4 8例 ,死亡 11例 ,平均住院日 93天 ,平均住院费 10万元 ,并发症发生高达 132人次 ;延期手术组 70例 ,死亡 1例 ,平均住院日 2 8天 ,平均住院费 5 .4万元 ,并发症发生 34人次。结论　绝大多数 SABP早期非手术治疗可缓解及治愈 ,仅有极少数病人需中转手术 ,延期手术病人并发症发生率及死亡率低 ,平均住院日短 ,平均住院费少 ,延期手术主要针对后期并发症如腹腔脓肿及假性胰腺囊肿 ,为预防胰腺炎复发 ,3～ 6个月应解决胆道疾患。区域性动脉灌注 (RAI)是早期治疗Objective To investigate reasonable model of treatment and operative timing of SABP.Methods 118 patients with SABP were retrospectively analyzed from Jan 1980 to Feb 2000 in our hospital,the patients were divided into early operative group and deferred operative group according to different treatment stages,the complications and main effects of treatment were studied.Results In early operative group,early operation was adopted in 48 patients,among them 37 recovered and 11 died,mortality 22.9%,complications took place 132 times,mean stay day in hospital was 93 days,mean hospital spending was 100 thousands yuan;In deferred operative group,RAI(regional arterial infusion)was adopted in 70 patients,among them 69 recovered and 1 died,mortality 1.4%,complications occurred 34 times,mean stay day and spending were 28 days and 54 thousands yuan.Conclusion Most SABP patients can be cured by RAI in early stage,only a few patients had o do operation,because the bilestone durably fixed the end of common bile duct,there were lower morbidity and mortality,shorter in hospital and less spending in deferred operative group than in early operative group.The objective of delayed opeartion is to solve the later stage complications such as abscess in abdominal cavity and pseudocyst in or around pancreas.The disease of bile duct should be solved in order to prevent the recurrence of pancreatitis.RAI is a safe and efficient method to treat SABP in early stage.

关 键 词：胰腺炎 胆源性 手术时机 区域性动脉灌注 

分 类 号：R657.51[医药卫生—外科学]