摘要
目的:探讨外科手术在重症急性胰腺炎(SAP)治疗中的作用。方法:回顾性分析2009年6月—2012年8月接受手术治疗的36例SAP患者的临床资料及治疗效果。结果:胆源性SAP 11例(30.5%),妊娠期SAP 2例(5.6%),酗酒或暴饮暴食者20例(55.6%),其他诱因3例(8.3%)。早期手术9例(25.0%),其中行胆囊切除、胆总管切开取石、T管引流、腹腔冲洗引流术7例,剖腹探查、胰腺区冲洗引流术2例;延期手术27例(75.0%),均行胰腺坏死组织清除、腹腔冲洗引流术,其中4例同时行胆囊切除、胆总管切开取石、T管引流术。2例死于多器官功能障碍综合征(MODS)及败血症,3例中途退院而失访,其余患者恢复良好,顺利出院。结论:手术是SAP治疗的关键环节之一,掌握恰当的手术时机和手术方式,可以有效降低并发症,提高疗效,挽救危重患者的生命。
Objective： To evaluate the efficacy of surgical intervention in the treatment of severe acute pancreatitis （SAP）. Methods： The clinical data and results of 36 SAP patients undergoing surgical treatment from June 2009 to August 2012 were retrospectively analyzed. Results： Among the 36 SAP patients, 11 cases （30.5%） were caused by biliary factors, 2 cases （5.6%） were associated with pregnanc）5 20 cases （55.6%） were due to alcohol abuse or overeating, and 3 cases were induced by other causes. Nine patients （25.0%） received early operation, of whom, 7 cases underwent cholecystectom）5 choledocholithotomy, T-tube drainage, and peritoneal lavage, while 2 cases underwent exploratory laparotomy and irrigation/drainage of the pancreatic bed. Twenty-seven patients received delayed operation;all of them underwent pancreatic necrosectomy and peritoneal lavage, and in 4 cases cholecystectomy, choledocholithotomy and T-tube drainage were simultaneously performed. Two patients died of multiple organ dysfunction syndrome （MODS） and sepsis, 3 patients refused continued hospitalization and were lost to follow-up because of noncompliance, and all other patients were discharged after full recovery. Conclusion： Surgery is an important component in the treatment of SAP; appropriate timing and surgical treatment methods can reduce complications, improve therapeutic efficac）5 and save the lives of critically ill patients.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2013年第9期1190-1194,共5页
China Journal of General Surgery
关键词
胰腺炎
急性坏死性
外科学
引流术
腹腔镜
临床路径
Pancreatitis, Acute Necrotizing/surg
Drainage
Laparoscope
Clinical Pathway
作者简介
许永庆，中国医科大学附属盛京医院副教授，主要从事肝胆胰外科基础与临床方面的研究。
