摘要
本文报告我院自1978年至1988年共治疗胆石性胰腺炎110例,其中61例行手术治疗。临床分类:水肿型72例占65.5%(手术证实29例),出血坏死型33例占30%(手术证实27例),慢性型5例占4.5%(均经手术证实)。行手术治疗的61例中,水肿型和慢性胰腺炎34例,31例行延期或择期手术,3例因合并急性梗阻性化脓性胆管炎(AOSC)行急症手术。出血坏死型胰腺炎27例,23例在住院24小时内行急症手术,4例为中转手术。手术死亡7例,均为出血坏死型,手术死亡率11.5%。分析本组资料,我们提出9项标准做为选择手术时机的参考指征,9项中最重要的是前4项,即1.症状:上腹剧疼、寒战、腹胀,明显黄疸,中毒症状明显,血压下降,脉搏加快。2.体征:全腹有压痛1或深压痛。3.腹腔穿刺有血性渗液,淀粉酶阳性。4.B 超发现结石或提示有胆总管扩张,胰腺肿胀。对出血坏死型胰腺炎的治疗,我们采用胰腺被膜切开减压+胰床多管引流+腹腔引流方法收到较好效果。
Of the 110 cases of biliary pancreatitis treated from 1978～1988,61 cases were ope-rated on.Clinical classification.edematous type:72 cases(65.5%),29 were confir-med by operation;hemorrhagic and necrotic type:33 cases(30%),27 confirmed byoperation;chronic type:5 cases(4.5%),all were confirmed by operation.Of the 61 operated cases,31 cases of edematous or chronic type were treated bydelayed or selective operation,3 cases were treated by emergency operation becauseof acute obstructive suppurative cholangitis(AOSC).In 27 cases of hemorrhagicand necrotic prncreatitis,23 were treated by emergency operation within 24 hoursafter admision,4 were treated by operation after initial nonoperative therapy.7 patients died after operation,all of the hemorrhagic and necrotic type.The operativemortality was 11.5%.Nine criteria was taken into consideration for indications of operation.The first4 were important,i.e.:1.Symptoms:severe epigastric pain,chill,abdominal disten-sion,marked jaundice,toxic symptoms,dropping of blood pressure,rapid pulse.2.Signs:tenderness or deep tenderness.3.Bloody effusion found in abdominal puncture,with high amylase level.4.Biliary stone detected or dilatation of the commonbile duct and enlarged pancreas shown by B-ultrasound.Incision of the pancreaticcapsule and decompression with multiple drainage of the pancreatic bed and abdominalcavity was satisfactory in treating patients with hemorrhagic and necrotic pancrea-titis.
出处
《天津医药》
CAS
1990年第4期204-207,共4页
Tianjin Medical Journal
