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目的:探讨重症急性胰腺炎手术与非手术治疗的临床效果,对比分析其优缺点,为治疗重症急性胰腺炎寻找最佳方案。方法:收治重症急性胰腺炎患者96例,根据治疗方案不同将患者分为非手术组、早期手术组和中转手术组。非手术治疗:在禁食、吸氧,胃肠减压的基础上给予大量糖皮质激素联合抗生素抗感染治疗,同时采用奥曲肽治疗,0.6mg/24小时持续静滴,病情缓解后改为0.1mg,每8小时1次,肌肉注射。乌司他丁治疗,乌司他丁10万U,溶于10%葡萄糖250ml静滴,1次/12小时,连用5～7天。密切观察患者生命体征及心、肺、肾等功能情况,一旦病情加重或恶化,立即转至手术治疗。本组资料有64例重症急性胰腺炎患者采用了手术治疗,其中早期手术治疗32例,中转手术治疗32例。结果:本组96例患者,总有效率53.1%,其中早期手术组总有效率43.75%,中转手术组总有效率53.1%,非手术治疗组总有效率62.5%。早期手术组死亡率明显高于非手术组死亡率,组间比较有显著差异(P<0.05);中转手术组死亡率虽高于非手术组,但组间比较无显著差异(P>0.05)。结论:对于重症急性胰腺炎患者,无手术指征患者采取积极的非手术治疗,对有手术指征患者要及时采取手术。
Objective: To investigate the clinical effect of surgical treatment and non-surgical treatment of severe acute pancreatitis, compare the advantages and disadvantages of the two methods, and find the best solution for the treatment of severe acute pancreatitis. Methods: A total of 96 patients with severe acute pancreatitis were divided into non-operation group, early operation group and transit operation group according to different treatment options. Non-surgical treatment: In the fasting, oxygen, gastrointestinal decompression on the basis of a large number of glucocorticoid combined antibiotics anti-infective treatment, while using octreotide treatment, 0.6mg / 24 hours continuous intravenous infusion, remission changed to 0.1mg , Every 8 hours, intramuscular injection. Ulinastatin treatment, ulinastatin 100,000 U, dissolved in 10% glucose 250ml intravenous infusion, 1/12 hours, once every 5 to 7 days. Closely observe the patient’s vital signs and heart, lung, kidney and other functional conditions, once the condition aggravates or worsens, immediately go to surgery. This group of data 64 patients with severe acute pancreatitis treated by surgery, including 32 cases of early surgical treatment, surgical treatment of 32 cases. Results: In this group of 96 patients, the total effective rate was 53.1%. The total effective rate in the early operation group was 43.75%. The total effective rate in the transit operation group was 53.1%. The total effective rate in the non-operation group was 62.5%. The mortality rate in the early operation group was significantly higher than that in the non-operation group (P <0.05). The mortality rate in the transit operation group was higher than that in the non-operation group, but there was no significant difference between the two groups (P> 0.05) . Conclusion: For patients with severe acute pancreatitis, patients without surgical indications take active non-surgical treatment, and patients with surgical indications should be promptly operated.