中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2015年
9期
672-675
,共4页
杨明%勾善淼%王春友%吴河水%熊炯炘%赵刚%周峰%陶京%杨智勇
楊明%勾善淼%王春友%吳河水%熊炯炘%趙剛%週峰%陶京%楊智勇
양명%구선묘%왕춘우%오하수%웅형흔%조강%주봉%도경%양지용
胰腺炎,急性坏死性%外科手术%手术指征%手术时机
胰腺炎,急性壞死性%外科手術%手術指徵%手術時機
이선염,급성배사성%외과수술%수술지정%수술시궤
Pancreatitis,acute necrotizing%Surgical procedures,operative%Surgical indication%Surgical timing
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.
目的 探討手術指徵、時機及方式對改善壞死性胰腺炎外科治療預後的意義.方法 2005年1月至2014年12月華中科技大學同濟醫學院附屬協和醫院胰腺外科共收治急性胰腺炎(AP)患者5 538例,其中CT影像確診的壞死性胰腺炎患者2 415例,篩選齣首次外科榦預即在該科進行的壞死性胰腺炎患者732例納入研究.男性439例,女性293例;年齡20～76歲,中位年齡45歲.732例患者中,行腹膜後微創清創引流289例,行開放壞死組織清除術者684例.結果 微創清創引流的治愈率為16.6％ (48/289),需要進一步行開放壞死組織清除術241例.行開放手術的684例患者中,感染性壞死523例(76.5％),髮病至首次開放手術的中位時間為46 d(範圍19～205 d).因壞死組織殘餘再次開放手術率為16.8％ (115/684),開放手術的684例患者人均開放手術的次數為1.26次.開放手術術後主要併髮癥包括腹腔內齣血(37例)、上消化道瘺(34例)、結腸瘺(12例)、胃腸道梗阻(29例)、胰瘺(83例),開放手術主要併髮癥髮生率為28.5％(195/684).732例壞死性胰腺炎患者中,術後死亡49例,病死率為6.7％(49/732).結論 閤理選擇手術指徵及手術時機是改善壞死性胰腺炎手術療效的關鍵,開放壞死組織清除術依然是壞死性胰腺炎的有效手術方式.
목적 탐토수술지정、시궤급방식대개선배사성이선염외과치료예후적의의.방법 2005년1월지2014년12월화중과기대학동제의학원부속협화의원이선외과공수치급성이선염(AP)환자5 538례,기중CT영상학진적배사성이선염환자2 415례,사선출수차외과간예즉재해과진행적배사성이선염환자732례납입연구.남성439례,녀성293례;년령20～76세,중위년령45세.732례환자중,행복막후미창청창인류289례,행개방배사조직청제술자684례.결과 미창청창인류적치유솔위16.6％ (48/289),수요진일보행개방배사조직청제술241례.행개방수술적684례환자중,감염성배사523례(76.5％),발병지수차개방수술적중위시간위46 d(범위19～205 d).인배사조직잔여재차개방수술솔위16.8％ (115/684),개방수술적684례환자인균개방수술적차수위1.26차.개방수술술후주요병발증포괄복강내출혈(37례)、상소화도루(34례)、결장루(12례)、위장도경조(29례)、이루(83례),개방수술주요병발증발생솔위28.5％(195/684).732례배사성이선염환자중,술후사망49례,병사솔위6.7％(49/732).결론 합리선택수술지정급수술시궤시개선배사성이선염수술료효적관건,개방배사조직청제술의연시배사성이선염적유효수술방식.
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.
