急性胆源性胰腺炎手术治疗.docVIP

急性胆源性胰腺炎手术治疗【摘要】 目的 探讨急性胆源性胰腺炎(ABP)的手术时机和手术治疗方式。方法 回顾分析112例ABP的临床资料。结果 23例急诊手术,分别进行了内镜下Oddi括约肌切开取石+腹腔镜胆囊切除术、胆道探查+胰腺包膜切开引流,发生并发症5例,死亡2例。89例延期手术,分别进行了腹腔镜胆囊切除术、开腹胆囊切除术、胆囊切除术+胆总管探查、胆囊切除+胆总管探查+左肝外叶切除、胆囊切除+胰腺假性囊肿内引流术,未发生严重并发症。结论 ABP首选非手术治疗,延期手术较急症手术有更大的安全性。 【关键词】 胰腺炎;胆源性;外科治疗 Surgical treatment ofacute biliary pancreatitis XIONG Da-fu,GUAN Xiao-dong.Department of the Second Surgery,the Zhuhai Second Peoples Hospital,Guangzhou 519000,China 【Abstract】 Objective To investigate the the timing of operation and surgical treatment of ABP. Methods The clinical data of 112 cases of ABP were retrospectively analyzed. Results 23 patients underwent emergency operation, they received endoscopic sphincterotomy(EST)+laparoscopic cholecystectomy,exploration of common bile duct+ capsula pancreatis incision and drainage, 5 cases had complications and 4 cases died. 89 patients underwent delayed operation, they received laparoscopic cholecystectomy(LC),open cholecystectomy, cholecystectomy+ exploration of common bile duct, cholecystectomy+ exploration of common bile duct+hepatectomy for left lateral, cholecystectomy+pancreatic pseudocyst internal drainage and no severe complications were observed. Conclusion Non-surgical treatment is the first choice for ABP, Delayed surgery operation hasgreater security than emergency operation. 【Key words】 Pancreatitis; Biliary; Surgical treatment 作者单位:519000珠海市第二人民医院外二科(熊大芾);珠海中山大学附属第五医院普外三科(关晓东) 外科手术是急性胆源性胰腺炎(acute biliary pancreatitis,ABP)的主要治疗方式,但是对胆源性胰腺炎的手术治疗时机及手术方式尚存在争议[1]。我科自1993年10月至2009年10月共收治ABP 112例,现报告如下。 1 临床资料 本组共计112例,其中男44例,女68例,年龄18～69岁,平均50.6岁。第二次发作以上者25例。诊断标准按中华医学会胰腺外科学组1997年推荐的“急性胰腺炎临床诊断及分级标准”[2]。依据APACHE-Ⅱ评分(acute physiology and chronic health evaluation scoreⅡ),轻症77例,重症35例。其中84例患者腹部CT显示胰腺形态肿胀、增大、边界模糊。28例患者腹部CT显示胰腺实质弥漫性或局灶性坏死,胰周密度不均,胰周或小网膜囊有积液。B超和CT提示胆囊结石74例,胆总管结石38例。 2 治疗方法 全部病例入院后均先给予禁食、输液、持续胃肠减压、抗炎、保肝、纠正水电解质平衡、纠正休克、应用生长抑素、全胃肠外营养支持等非手术治疗。非手术治疗过程中,如患者出现腹痛加剧,腹膜炎体征加重,黄疸进行性加深、发热等化脓性胆管炎表现时,急诊进行手术。23例急诊手术,分