区域动脉灌注治疗入院时的Ⅱ级重症急性胰腺炎  

Regional intra-arterial infusion treatment for grade Ⅱ severe acute pancreatitis when admitted to hospital

作　　者：周蒙滔[1] 张启瑜[1] 施红旗[1] 陈笑雷[1] 

机构地区：[1]温州医学院第一附属医院肝胆外科,浙江温州325000

出　　处：《温州医学院学报》2003年第3期173-175,共3页Journal of Wenzhou Medical College

摘　　要：目的:探讨区域动脉灌注治疗入院时即合并有胰外脏器功能障碍的重症急性胰腺炎(亦称Ⅱ级重症急性胰腺炎,Ⅱgrade serve acute pancreatitis,SAP-Ⅱ)患者的可行性及其他治疗要点,以期提高疗效。方法:1999年8月以来,采用早期区域动脉灌注5-FU、奥曲肽治疗6例SAP-Ⅱ患者,并以自1995年6月至1999年7月间采用早期手术治疗的6例SAP-Ⅱ患者作为对照组,比较两组的病死率、并发症发生率、平均住院时间、平均住院费用。结果:手术组的病死率为50％,并发症发生率为100％,平均住院时间为76.3d,平均住院费用为18.4万元;早期区域动脉灌注组的病死率为0,并发症发生率为33.3％,平均住院时间为37.3d,平均住院费用为5.4万元,经x^2检验,二组的死亡率(P<0.05)、并发症发生率(P<0.05)的差异有显著性。结论:①早期采用区域动脉灌注针对重症急性胰腺炎的治疗是入院时SAP-Ⅱ患者的治疗关键。②妥善处理胰外脏器功能障碍是提高入院时SAP-Ⅱ患者疗效的重要环节。③手术治疗主要针对入院时SAP-Ⅱ患者晚期局部感染并发症与消化道瘘、大血管糜烂出血等。Objective:To explore the feasibility of the regional intra-arterial infusion for the treatment of severe acute pancreatitis with other organ dysfunction (grade Ⅱ severe acute pancreatitis, SAP- Ⅱ ) when admitted to hospital, to evaluate the other therapeutic outlines, and to improve the therapeutic effectiveness of SAP- Ⅱ .Methods:The regional intra-arterial infusions with 5-fluorouracil or Octreotide in early stage have been adapted to treat 6 cases with SAP- Ⅱ when admitted to hospital since August 1999, and 6 cases with SAP- Ⅱ who underwent early operation from June 1995 to July 1999 were regarded as the control group. The mortality, incidence of complication, the mean time of hospitalization and the mean hospitalization expenses of two groups were compared. Results: The mortality, incidence of complication, the mean time of hospitalization and the mean hospitalization expenses of the operative group were 50% , 100%, 76.3 days and 184,000 yuan , respectively. They were much higher than that of the regional intra-arterial infusion group (0, 33.3% , 37.3 days, and 54,000 yuan, respectively) . Through chi2 check, the difference of the mortality and incidence of the complication of both group had the statistical significance ( P < 0.05 and P < 0.05, respectively) Conduson: (1)Using the regional intra - arterial infusion to treat severe acute pancreatitis in early stage is the key of treatment for cases with SAP- Ⅱ when admitted to hospital.(2)To treat properly other organ dysfunction is an important therapeutic procedure of SAP-Ⅱ when admitted to hospital.(3)The operation in late stage was performed to treat the local infectious complication, alimentary tract fistula or the bleeding of the vascular erosion in cases with SAP-Ⅱ when admitted to hospital.

关 键 词：胰腺炎 脏器功能障碍 动脉内灌注 外科手术 

分 类 号：R657.51[医药卫生—外科学]