摘要
目的探讨老年重症急性胆源性胰腺炎(SABP)的临床特点与微创治疗的方式,以及治疗时机的选择。方法选取2005年5月—2012年5月在徐汇区大华医院和徐汇区中心医院接受治疗的60例老年SABP患者,分别经B超、CT、磁共振胰胆管造影(MRCP)和实验室检查等明确诊断,采用保守治疗和内镜下胆管取石和(或)置管引流、经皮肝胆管引流术(PTCD)治疗、局部穿刺脓肿引流、胆道手术等微创方式进行治疗。结果合并胆道梗阻的SABP患者36例(60.0%,36/60),其中行内镜下胆管取石和(或)置管引流治疗26例,PTCD治疗8例,保守治疗2例;治愈20例,好转(胰腺炎控制)12例,因急性呼吸窘迫和急性肾衰竭死亡4例。未合并胆道梗阻的SABP患者24例,其中行内镜下胆管取石和(或)置管引流治疗4例,行保守治疗20例;治愈13例,好转(胰腺炎控制)7例,因心、肺和肾脏功能衰竭死亡4例。本组60例中,治愈33例(55.0%),好转19例(31.7%),死亡8例(13.3%),治疗总有效率为86.7%(52/60)。合并胰腺假性囊肿8例(13.3%,8/60),行保守治疗5例,行囊肿内引流术3例;均治愈。合并胰周脓肿6例(10.0%,6/60),均于B超引导下行局部穿刺置管引流,治愈3例,死亡3例。结论应加强老年SABP患者心、肺和肾脏等重要脏器功能维护,采取个体化的治疗是关键,微创技术是治疗伴有胆管梗阻的SABP有效、首选治疗方法。
Objective To investigate clinical feature and minimally invasive treatment for senile severe acute biliary pancreatitis （SABP） and to search for suitable operative timing for SABP. Methods Sixty elderly SABP patients who were treated in Dahua Hospital of Shanghai Xuhui District and Central Hospital of Shanghai Xuhui District from May 2005 to May 2012 were enrolled in the study. All the patients were diagnosed by B ultrasound, CT, magnetic resonance cholangiopancreatography （MRCP） and laboratory tests. Non-surgical comprehensive treatment and multiple minimally invasive treatments, including endoscopic calculus removed surgery and/or drainage, percutaneous transhepatic cholangial drainage （PTCD） treatment, parapancreatic abscess drainage by percutaneous puncture and biliary tract surgery, were used for treatment. Results Biliary obstruction occurred in 36 patients （60.0%, 36/60） ; of them, 26 were treated with endoscopic calculus removed surgery and/or drainage, 8 with PTCD, and 2 with expectant treatment; eventually, 20 cases were cured, 12 cases improved, and 4 cases died from acute respiratory distress and acute renal failure. There were another 24 ones without biliary obstruction （40.0%, 24/60）; of them, 4 cases were treated with endoscopic calculus removed surgery and/or drainage, and 20 cases received expectant treatment; finally, 13 cases were cured, 7 cases improved, and 4 cases died from heart, lung and renal failure. Among the 60 SABP patients, 33 were cured （55.0%）, 19 improved （31.7%）, and 8 cases died （ 13.3% ）, with an effective rate of 86.7% （52/60）. Pancreatic pseudocyst occurred in 8 patients （13.3 %, 8/60） who were cured after expectant treatment in 5 cases and drainage in 3 cases. Parapancreatic abscess drainage was performed under B ultrasound guidance in 6 patients （10.0%, 6/60）; 3 were cured and another 3 died. Conclusion The maintenance of heart, lung and kidney function should be reinforced in elderly patients with SABP. It is very important to co
出处
《上海医学》
CAS
CSCD
北大核心
2013年第9期801-804,共4页
Shanghai Medical Journal
关键词
重症急性胰腺炎
胆源性
临床特点
微创
治疗
Severe acute pancreatitis
Biliary
Clinical feature
Minimally invasive
Treatment
