摘要
目的探讨重症胰腺炎（ＳＡＰ）最佳手术时机和手术方式。方法对１９８５年～１９９４年间收治的５０例ＳＡＰ患者手术时机、术式及病死率进行回顾性分析。结果（１）手术病死率为１４％，其中８５．７％为４０～６０岁年龄段患者。性别及病因分类无差异。（２）随手术距发病时间延长，病死率逐渐降低，但差异无显著性（Ｐ＞０．０５）。（３）随手术距入院时间延长，病死率明显降低，入院１２小时内手术者病死率显著高于其他时间组（Ｐ＜０．０１）。（４）随胰坏死程度及胰外器官受累个数增加，手术病死率显著增加（Ｐ＜０．０１及Ｐ＜０．０５）。（５）休克、胰坏死及多脏器功能衰竭（ＭＯＦ）的相关病死率分别为３１．８％、３１．６％和２８．０％（Ｐ均＜０．０５）。（６）术式以胆胰联合手术及单纯胰病灶清除引流为主。结论ＳＡＰ手术时机是影响手术病死率的重要因素，最佳时机的选择应与ＳＡＰ自然病程相适应，避免在发病后１～７天，尤其在入院１２小时内手术。强调术前给予至少２４小时支持治疗。术式选择应以简单有效，充分引流，清除病灶，去除病因为基本原则。
Objective To investigate the timing and mode of surgical management in patients with severe acute pancreatitis (SAP). Method The timing, mode of operation and mortality were reviewed retrospectively in 50 SAP cases undergoing laparotomy in our hospital from 1985 to 1994. Result The overall mortality was 14 % and 85.7 % of the mortality falls on the age between 40 to 60 years, with no difference in etiology and sex. The operative mortality reduced gradually in patients with longer duration of illness ( P >0 05). The operative mortality of 31.8 % in patients undergoing laparotomy within 12 h after hospitalization was significantly higher ( P <0.05) than in these operated on later.When the number of injured extra pancreatic organs increased, the mortality also increased significantly (χ 2=5 99, P <0 05).The related mortality with shock,pancreatic necrosis and multiorgan failure (MOF) was 31 8 %, 31 6 % and 28 %, respectively ( P <0 05).The main procedures of surgical management were pancreatic debridement and/or drainage, and combined surgical measures. Conclusion The laparotomy timing is an important factor influencing mortality as well as the severity of pancreatic necrosis, sepsis, and MOF.Delayed laparotomy and 24 h preoperative management is recommended.Surgery adopted should be simple,efficient in drainage and debridement.
出处
《中华外科杂志》
CAS
CSCD
北大核心
1998年第4期215-217,共3页
Chinese Journal of Surgery
关键词
胰腺炎
外科手术
手术时机
术式
Pancreatitis Surgery,operative Clinical protocols
