摘要
目的 探讨手术指征、时机及方式对改善坏死性胰腺炎外科治疗预后的意义.方法 2005年1月至2014年12月华中科技大学同济医学院附属协和医院胰腺外科共收治急性胰腺炎（AP）患者5 538例,其中CT影像确诊的坏死性胰腺炎患者2 415例,筛选出首次外科干预即在该科进行的坏死性胰腺炎患者732例纳入研究.男性439例,女性293例;年龄20-76岁,中位年龄45岁.732例患者中,行腹膜后微创清创引流289例,行开放坏死组织清除术者684例.结果 微创清创引流的治愈率为16.6％ （48/289）,需要进一步行开放坏死组织清除术241例.行开放手术的684例患者中,感染性坏死523例（76.5％）,发病至首次开放手术的中位时间为46 d（范围19-205 d）.因坏死组织残余再次开放手术率为16.8％ （115/684）,开放手术的684例患者人均开放手术的次数为1.26次.开放手术术后主要并发症包括腹腔内出血（37例）、上消化道瘘（34例）、结肠瘘（12例）、胃肠道梗阻（29例）、胰瘘（83例）,开放手术主要并发症发生率为28.5％（195/684）.732例坏死性胰腺炎患者中,术后死亡49例,病死率为6.7％（49/732）.结论 合理选择手术指征及手术时机是改善坏死性胰腺炎手术疗效的关键,开放坏死组织清除术依然是坏死性胰腺炎的有效手术方式.
Objective To investigate the indication,timing and methods of surgery for acute necrotizing pancreatitis.Methods There were 5 538 patients with acute pancreatitis （AP） were treated in the Union Hospital,Tongji Medical College from January 2005 to December 2014.Of all AP cases,2 415 patients with acute necrotizing pancreatitis proved by computed tomography,and 732 patients underwent surgical treatment.Among 732 patients with surgical treatment,439 （60.0%） were males and two hundreds and ninety-three （40.0%） were females.The median age was 45 years,ranging 20-76 years.Two hundreds and eighty-nine cases were treated with minimally invasive debridement and drainage and 684 cases were treated with open debridement.Results The cure rate of minimally invasive operation was 16.6% （48/289）.The rest of the 241 patients were treated furtherly with open necrosectomy.Among 684 patients with open surgery,523 patients （76.5%） were infected,and the median time from the onset of symptom to first open operation was 46 d（range 19-205 d）.There were 115 patients need to surgery again because of necrotic tissue residual and the reoperation rate was 16.81% （115/684）,684 patients were performed open surgery on average 1.26 times per person.The main postoperative complications were intra-abdominal hemorrhage（37 cases）,upper digestive tract fistula （34 cases）,colonic fistula （12 cases）,gastrointestinal obstruction （29 cases） and pancreatic fistula（83 cases）.The overall incidence of complications were 28.5% （195/684）.Forty-nine cases died after surgery and the mortality rate was 6.7% （49/732）.Conclusion Rational surgical indications and timing of surgical intervention are the key to improve the efficacy of necrotizing pancreatitis,open debridement is still an effective method for necrotizing pancreatitis.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2015年第9期672-675,共4页
Chinese Journal of Surgery
关键词
胰腺炎
急性坏死性
外科手术
手术指征
手术时机
Pancreatitis,acute necrotizing
Surgical procedures,operative
Surgical indication
Surgical timing
