急性胆源性胰腺炎160例治疗方法探讨

急性胆源性胰腺炎160例治疗方法探讨

（作者： _________ 单位：___________ 邮编：___________ ）

【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（P0.05）。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（P0.05）；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

（P0.05）。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 operati on tim ing of acute biliary pan creatitis. 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 'thave statistical significanee (P0.05). In 34 cases of severe non [obstructive type, the death rate, and organ dysfu ncti on betwee n early operati on and non Joperati on groups had significant statistical differenee (P0.05). In 30 cases of severe obstructive type, the death rate between early operation and non Joperati on group had statistical differe nee (P0.05). Con clusi on The treatme nt of acute biliary pan creatitis should be accord ing to the type. The non_ operatio n

effect was good for mild

non]obstructive type, but the mild obstructive type should be followed by operati on in opti onal 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 Jtime (24 〜72 hours) non_operation measures. If the biliary obstruction was not relived, the n the emerge nt operati on was carried out to remove biliary obstructio n.

［Key words ］acute biliary pancreatitis; clinical classification; biliary obstruction; treatment

急性胆源性胰腺炎的特殊性在于其发病原因为胆道疾病所致，胰腺炎症伴发胆道梗阻甚至胆管炎，病情复杂且变化多端，何时解决胆道问题，怎样解决胆道问题，成为临床工作中争论的一个焦点］1，2］。为此，笔者总结了两院自2002年12月至2007年7月收治的急性胆源性胰腺炎160例，按入院时是否存在胆道梗阻和急性胰腺炎的严重程度分型，以探讨急性胆源性胰腺炎治疗方案的选择。

1对象与方法

1.1病例

本组急性胆源性胰腺炎患者共160例，其中男81例，女79例，比例接近1 1。年龄11 ~ 88岁，平均54岁。经影像学及手术证实有胆囊结石104例，胆总管结石或扩张46例，肝内胆管结石1例，胆总管囊肿3例，胆囊癌1例，胆道有阻塞性黄疸表现者9例。按文献分级标准］3］，本组轻型96例，重型64例。其中轻型伴血脂升高者7例，伴血钙下降者5例；重型伴血脂升高者10例，伴血钙下降者10例。

1.2诊断标准

急性胆源性胰腺炎的诊断标准：①有胆道疾病史；②血淀粉酶超过正常3倍以上；③肝功能损害伴黄疸；④影像学检查提示胆囊或胆总管结石合并急性胰腺炎；⑤部分病例经过手术探查证实。胆道梗阻诊断标