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目的探讨急性非胆源性重症型胰腺炎治疗方法。方法回顾分析近1 0年间收治的54例急性非胆源性重症型胰腺炎患者的临床资料。将其分为3组:Ⅰ组为急诊手术组1 5例(系前5年收治入院保守治疗7 2 h手术者);Ⅱ组为简捷手术+非手术治疗(针对并发症治疗者)2 4例;Ⅲ组为简捷手术+后期手术治疗组(并发胰腺脓肿者1 5例)。结果5 4例患者治愈5 1例(9 4.5%),其中2 4例并发胰腺囊肿2期手术治愈,3例死亡(5.5%)(均系急诊手术组),1例死于急性呼吸窘迫综合征(ARDS),1例死于感染中毒性休克,1例死于术后多器官系统衰竭(MOSF)。Ⅱ和Ⅲ组均无死亡病例。结论急性非胆源性重症型胰腺炎早期强化全身支持治疗,维护脏器功能和内环境稳定甚为关键,应该针对其并发症进行序贯性治疗,炎症反应高峰期采用简捷手术(局麻下腹腔置管引流处理),可延缓胰腺病变进程,对形成胰腺脓肿者及时手术治疗,术后持续腹腔灌洗,可明显提高治愈率。
Objective To investigate the treatment of acute non-biliary severe pancreatitis. Methods The clinical data of 54 patients with acute non-biliary severe pancreatitis admitted in recent 10 years were retrospectively analyzed. They were divided into 3 groups: group Ⅰ was 15 cases of emergency operation group (admitted to hospital in the first 5 years of conservative surgery 7 2 h operation); Ⅱ group of simple operation + non-surgical treatment (for the treatment of complications) 2 4 Cases; Ⅲ group for the simple operation + late surgery group (complicated by pancreatic abscess in 15 cases). Results 54 patients were cured 51 cases (9.45%), of which 24 cases were complicated with pancreatic cyst 2 operations were cured, 3 cases were dead (5.5%) (both emergency surgery group), 1 patient died of acute respiratory distress syndrome One case died of infectious toxic shock and one case died of postoperative multiple organ system failure (MOSF). No deaths occurred in group Ⅱ and Ⅲ. Conclusion Acute non-biliary severe pancreatitis in the early strengthening of body support and maintenance of organ function and stability of the internal environment is critical, should be sequential treatment of its complications, the peak of inflammatory response using a simple procedure Peritoneal catheter drainage), can delay the progression of pancreatic lesions, the formation of pancreatic abscess and timely surgical treatment, continuous abdominal irrigation, can significantly improve the cure rate.