急性胆源性胰腺炎160例治疗方法探析.docVIP

急性胆源性胰腺炎160例治疗方法探析 　【摘要】 目的： 探讨急性胆源性胰腺炎的治疗方法和手术时机。方法： 回顾性分析急性胆源性胰腺炎160例，其中轻症非梗阻型34例、轻症梗阻型62例、重症非梗阻型34例、重症梗阻型30例，对比不同治疗方法下各型患者的死亡率、功能不全脏器数。结果： 在轻症非梗阻型、轻症梗阻型病例中，不同治疗方法间各指标比较无统计学意义(Pgt;0.05)。重症非梗阻型34例中，早期手术死亡率、功能不全脏器数和非手术患者相比，差异有统计学意义 (Plt;0.05)；重症梗阻型30例中，早期手术死亡率和非手术患者相比，差异有统计学意义 (Plt;0.05)。结论： 对急性胆源性胰腺炎应分型而治。轻症非梗阻型，非手术治疗效果好；轻症梗阻型，一般采取保守治疗，然后择期手术治疗；重症非梗阻型，先积极保守治疗，再根据胰腺坏死是否感染决定是否手术；重症梗阻型，先行短期(24～72小时)积极的非手术治疗，若胆道梗阻未解除，则急诊手术解除胆道梗阻。 【关键词】 急性胆源性胰腺炎； 临床分型； 胆道梗阻； 治疗 ［Abstract］ Objective: To discuss the treatment method and operation timing of acute biliary pancreatitis. Methods： A total of 160 cases of acute biliary pancreatitis were reviewed, in which the cases number of the mild nonobstructive type, mild obstructive type, severe nonobstructive type, and the severe obstructive type were 34,62,34,30 respectively. The death rate, organ dysfunction of different treatment scheme were analyzed. Results： In mild nonobstructive and mild obstructive type, the indexes of different treatment methods didn′t have statistical significance (Pgt;0.05). In 34 cases of severe nonobstructive type, the death rate, and organ dysfunction between early operation and nonoperation groups had significant statistical difference (Plt;0.05). In 30 cases of severe obstructive type, the death rate between early operation and nonoperation group had statistical difference (Plt;0.05). Conclusion： The treatment of acute biliary pancreatitis should be according to the type. The nonoperation effect was good for mild nonobstructive type, but the mild obstructive type should be followed by operation in optional time.For the severe nonobstructive type, the conservative treatment was firstly taken, and operation may be decided according to the infection. The severe obstructive type was firstly treated in shorttime (24～72 hours) nonoperation measures. If the biliary obstruction was not relived, then the emergent operation was carried out to remove biliary obstruction. ［Key words］ acute bilia