摘要
目的探讨胆石性胰腺炎合理的临床分型方法,以更好地指导临床选择治疗方案。方法依据胰腺炎的病情严重程度和胆管有无梗阻,将273例胆石性胰腺炎分成4个临床类型:非梗阻性轻型(Ⅰ型)、梗阻性轻型(Ⅱ型)、梗阻性重型(Ⅲ)、非梗阻性重型(Ⅳ型);再依据胆总管内是否存在结石,将每一类型分成a、b两个亚型。然后对临床分型结果、治疗方法、预后进行分析。结果Ia型34例,Ⅰb型112例;Ⅱa型59例,Ⅱb型11例;Ⅲa型6例,Ⅲb型4例;Ⅳa型3例,Ⅳb型44例。全组总病死率为3.3%(9/273),Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型的病死率分别为0、0、10%(1/10)、17.0%(8/47),组间差别具有统计学意义(P〈0.05)。早期手术、传统非手术以及早期区域动脉灌注治疗Ⅳ型的病死率分别为30.8%(4/13)、25%(3/12)、4.5%(1/22),区域动脉灌注组病死率显著低于其他两组(P〈0.05)。结论4型2分法是一种较为合理的胆石性胰腺炎临床分型法。以临床分型为依据细化胆石性胰腺炎治疗原则,可提高临床疗效。但在治疗过程中还需重视临床类型的转变。
Objective To propose a rational clinical classification of gallstone pancreatitis for better guide and select clinical treatment scheme. Methods On the basis of severity of pancreatitis and the presence or absence of biliary obstruction, 273 cases of gallstone panereatitis were classified into four types: non-obstructive mild type ( type Ⅰ ), obstructive mild type ( type Ⅱ), obstructive severe type ( type m ), non-obstructive severe type (type Ⅳ). Moreover, according to the presence or absence of common bile duct stone, every type was further classified into two subtypes: subtype a and subtype b. Then, the results of clinical classification, treatment methods and prognosis were analyzed. Results I a subtype: 34 cases, I b subtype:112 cases; Ⅱ a subtype: 59 cases,Ⅱb subtype: 11 cases; Ⅲa subtype: 6 cases, mb subtype: 4 cases; Ⅳa subtype : 3 cases, Ivb subtype : 44 cases. The overall mortality was 3.3% (9/273), the mortality in Ⅱ type, Ⅱ type, Ⅲ type or Ⅳ type was 0, 0, 10% ( 1/10), 17.0% (8/47), respectively. The difference was statistically significant ( P 〈 0.05 ). The mortality of Ⅳ type in early operation group, traditional non-operative group, and regional intra-arterial infusion group was 30.8% (4/13), 25% (3/12), 4.5% ( 1/22), respectively. The mortality of regional intra-arterial infusion group was significantly lower than those in other two groups ( P 〈 0.05 ). Conclusions This 4 types and 2 subtypes classification method of gallstone pancreatitis was rational. The treatment efficacy may be improved according to the clinical classification. However, attention shall be paid to the transformation of these clinical types.
出处
《中华胰腺病杂志》
CAS
2009年第4期219-221,共3页
Chinese Journal of Pancreatology
关键词
胰腺炎
胆石
临床类型
Pancreatitis
Gallstones
Clinical classification