胆源性复发性胰腺炎87例的临床分析  

Clinical analysis of 87 cases of recurrent biliogenic pancreatitis

作　　者：乔华[1] 何世举[2] 

机构地区：[1]重庆市第三人民医院消化内科,400014 [2]重庆市第三人民医院肝胆外科,400014

出　　处：《重庆医学》2003年第6期740-741,共2页Chongqing medicine

摘　　要：目的　总结胆源性复发性胰腺炎的诊治体会 ,以利进一步提高诊治水平。方法　对 87例胆源性复发性胰腺炎的临床资料进行回顾性分析。结果　 87例占同期胆源性胰腺炎的 2 2 .9% (87/ 380 ) ,二次发病者 4 8例 (水肿型 4 1例 ,重型 7例 ,其中死亡 1例 ) ,三次以上发病者 39例 (水肿型 2 5例 ,重型 14例 ,其中死亡 4例 )。复发间期以 3周内 12例 (13.8% ) ,6周内 37例(4 2 .5 % ) ,8周内 32例 (36 .8% )为主。约 90 %的有诱发因素。本组手术治疗 5 8例 ,死亡 2例 (3.4 % )。手术时间为保守治疗 (水肿型 )炎症控制后 (3～ 4周 ) ,方式以胆囊切除为主 ,若有胆总管结石则探查取石 ,T管引流 ,以及假性胰腺囊肿 空肠Y式吻合等 ,效果优良。保守治疗 2 9例 ,死亡 3例 (10 .3% )。结论　胆源性复发性胰腺炎的诊断应分型、分级。经保守治疗 ,使胰腺炎症控制后 3周左右 ,及时手术 ,可有效减少其复发。Objective To summarize the experience in diagnosis and treatment of recurrent biliogenic pancreatitis and to improve the therapeutic level.Methods 87 cases of recurrent biliogenic pancreatitis were analyzed on clinical materials retrospectively.Results 87 cases constituted 22.9% in the total 380 cases of biliogenic pancreatitis at the same time. 48 cases were bi diseased, of whom, 41 cases were edematous, 7 cases were serious, 1 case was dead ; 39 cases were tri diseased and repeatedly diseased, of whom, 25 cases were edematous,14 cases were serious, 4 cases were dead . 12 cases (13.8%) recurrent intervals were within 3 weeks, 37 cases (42.5%) within 6 weeks, 32 cases (36.8%) within 8 weeks. About 90% patients had the revulsive factors. In this group, 58 cases received surgical treatment, 2 of them were dead (3.4%). Operation time was after conservative treatment and inflammation control (3 to 4 weeks), cholecystectomy was the main method, choledochus exploration would be performed if the calculus was found, T tube drainage and Y type cysto jejunostomy of pancreas, etc. This was very effective. 29 cases received conservative treatment, 3 of them were dead (10.3%). Conclusion The diagnosis of recurrent biliogenic pancreatitis would be distinguished among differing cases and differing stages for treatment. After conservative treatment, controling the symptom of pancreatitis for about 3 weeks, cholecystectomy should be performed in time . The recurrence may be reduced effectively.

关 键 词：胆源性 胰腺炎 复发 诊断 治疗 

分 类 号：R657.51[医药卫生—外科学]