急性胆源性胰腺炎诊断及治疗探析.docVIP

急性胆源性胰腺炎诊断及治疗探析【摘要】 目的 探讨急性胆源性胰腺炎的诊断方法和治疗的选择。方法 对近10年我科256例急性胆源性胰腺炎的临床资料分析。结果 218例(占85.2%)为急性间质水肿型胰腺炎,38例(占14.8%)为急性坏死性胰腺炎。急性胆囊源性胰腺炎157例(占61.3%),急性胆管源性胰腺炎99例(占38.7%)。全组均先经药物保守治疗,其中201例(占82%)治愈后延期手术,18例(占7%)行早期手术,28例(占10.9%)行急症手术中死亡2例(占7.1%)。全组病死率为0.8%。结论 在临床上急性胆源性胰腺炎可分为急性胆囊源性和急性胆管源性两种类型,在治疗上有非梗阻性和梗阻性之分。首先均应先予以药物保守治疗为宜,前者容易保守治愈后行择期手术,后者可能并发化脓性胆管炎和胰腺坏死,需急症手术或保守治疗无效时则需及早手术。 【关键词】 胆源性胰腺炎;诊断;治疗 Diagnosis and treatment of acute biliary pancreatitis LU Zhi-kun,ZHANG Quan-feng.Department of General Surgery,The Gaozhou Hospitai of TCM,Guangdong Maoming,525200,China 【Abstract】 Objective To explore the diagnostic methods and the effect of treatmemt of biliary pancreatitis.Methods The clinical data of biliary pancreatitis in 256cases for 11years were analyzed retrospectively.Results There were acute interstitial edematous pancreatitis in 218cases(85.2%)and acute necrotizing pancreatitis in 38cases(14.8%)in pathology.157(61.3%)cases were cholecystic pancreatitis and 99(38.7%)cholangeitic pancreatitis.All cases were treated with medicine at first.There were postponent operation after cure of drugs in 210(82.0%)and 18(7%)cases early operation were perfomed.28cases(10.9%)must need do emergent operation and death from emergent operation in2(7.1%).Total morality was 0.8%.Conclusion biliary pancreatitis may divided two types of cholecystic pancreatitis and cholangeitic pancreatitis and may divided of non-obstructive or obstructive at treatment.All cases should treatment with conservative procedure at first and then postponent operation were performed.Cholangeitic pancreatitis may follow by suppurative cholangitis and pancreatic necrosis,it need emergent or early operation if conservative therapy failure. 【Key words】 Biliary pancreatitis;Diagnosis;Therapy 近10年来随着人们生活水平的提高和饮食结构的改变胆石症的发病率增加,以致胆源性胰腺炎的发病率也有不断上升的趋势。现将本院1998年10月到2008年12月间共收治急性胰腺炎490例病资料,其中胆源性胰腺炎有256例,占52.2%。现对其诊断及治疗方法的选择作总结性分析如下。 1 资料与方法 1.1 一般资料 256例中,男78例(30.5%),女154例(69.5%),男:女为1:2.0。年龄最小25岁,