胆源性急性胰腺炎治疗体会.docVIP

胆源性急性胰腺炎治疗体会 　　[摘要] 目的：探讨胆源性急性胰腺炎的手术时机及方式的选择。方法：回顾性总结和分析本院57例胆源性急性胰腺炎的临床资料。采用保守治疗、早期手术治疗和择期手术治疗。结果：本组保守治疗25例，治愈24例，死亡1例；手术治疗32例，治愈29例，死亡3例。结论：早期保守治疗，病情恶化时需急诊手术治疗；保守治疗至病情稳定后，择期手术治疗。选择合适手术时机是“个体化”治疗胆源性急性胰腺炎的重要环节。 　　[关键词] 胆源性急性胰腺炎；保守治疗；手术治疗；手术方式 　　[中图分类号] R657.5 [文献标识码] A [文章编号] 1674-4721（2011）12（b）-048-02 　　 　　The experience of biliary acute pancreatitis 　　WU Jiang 　　Department of General Surgery, Datong Coal Mine Group Company General Hospital, Shanxi Province, Datong 037003, China 　　[Abstract] Objective: To investigate the treatment way and surgical operation opportune moment of the study biliary acute pancreatitis of choice. Methods: Summarized and analyzed clinical data of 57 patients with bile source pancreatitis. All 57 patients were treated with the conservative treatment, early operation therapy and elective operation treatment. Results: The group of conservative treatment in 25 cases, 24 cases were cured, 1 case death; operation treatment in 32 cases, 29 cases were cured, 3 cases died. Conclusion: Early conservative treatment, his condition worsened emergency operation treatment; conservative treatment to stable condition after treatment, elective operation. Select the appropriate operation time is “individual” in the treatment of acute biliary pancreatitis important link. 　　[Key words] Biliary acute pancreatitis; Conservative treatment; Operation treatment; Operation method 　　 　　急性胰腺炎有多种致病危险因素，国内以胆道疾病为主，占50％以上，称胆源性急性胰腺炎（acute biliary pancreatitis，ABP）。如何选择胆源性急性胰腺炎的治疗方法，尽早解除和减轻胆源性急性胰腺炎的病因，掌握好手术时机，尚无统一的标准。为此，笔者回顾分析了本院普外科2006年3月～2011年1月收治的57例胆源性急性胰腺炎临床资料，现报道如下： 　　1资料与方法 　　1.1一般资料 　　本组胆源性急性胰腺炎患者共计57例，其中，男24例，女33例；年龄22～77岁，平均（49.5±9.5）岁。入院前病程3～150 h，平均（76.5±10.5） h。 　　1.2临床表现及诊断 　　57例胆源性急性胰腺炎患者均有上腹或左上腹及全腹痛症状，均急性起病。经B型超声、CT和MRCP检查提示：所有患者均发现胆总管扩张并伴有胰腺肿大或胰周积液。胆囊结石伴急性胆囊炎35例，胆总管结石14例，肝内外胆管结石4例，胆道肿瘤2例，胆道蛔虫2例。实验室检查，血、尿淀粉酶均不同程度升高。血清谷丙转氨酶（ALT）值80～200 U/L（正常值10～40 U/L）者30例，血清谷草转氨酶（AST）值80～200 U/L（正常值10～40 U/L）者28例，血清总胆红素（TBIL）值≥30 μmol/L（正常值3.4～17.1 μmol/L