• 貴陽醫(yī)學(xué)院附屬醫(yī)院肝膽外科(貴州貴陽 550004);

目的總結(jié)暴發(fā)性胰腺炎(FAP)的臨床特點(diǎn)及診治經(jīng)驗(yàn)。方法對2008年5月至2010年7月期間我院收治的18例FAP患者的臨床特點(diǎn)及治療進(jìn)行回顧性分析。結(jié)果18例患者中,2例膽源性FAP患者急診行膽總管切開減壓加T管引流術(shù),術(shù)后痊愈1例,死亡1例; 5例發(fā)生腹腔間隔室綜合征者選擇急診手術(shù)行胰腺被膜切開減壓加引流術(shù),治愈3例,死亡2例; 其余11例患者通過呼吸支持、腹腔灌洗等治療,其中1例高齡患者既往有冠心病因心功能衰竭而死亡,5例胰腺壞死感染,采取胰腺周圍壞死組織清除加引流手術(shù),并根據(jù)細(xì)菌及真菌培養(yǎng)結(jié)果聯(lián)合使用抗細(xì)菌及真菌藥物治療,3例治愈,2例感染未能控制引發(fā)多器官功能障礙綜合征而死亡。本組共死亡6例。結(jié)論FAP的治療與一般的重癥急性胰腺炎相比,有其專有的特點(diǎn),更注重整體一體化治療,要求外科醫(yī)生和ICU醫(yī)生協(xié)同,保護(hù)好患者的臟器功能,在全程監(jiān)護(hù)的條件下給予呼吸循環(huán)支持,同時(shí)第一時(shí)間針對患者的病情采取血液濾過、腹腔灌洗、微創(chuàng)手術(shù)等治療。

引用本文: 潘耀振,孫誠誼. 暴發(fā)性胰腺炎的治療體會(huì)(附18例報(bào)道). 中國普外基礎(chǔ)與臨床雜志, 2011, 18(3): 255-257. doi: 復(fù)制

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2. Bosscha K, Hulstaert PF, Hennipman A, et al. Fulminant acute pancreatitis and infected necrosis: results of open management of the abdomen and “planned” reoperations [J]. J Am Coll Surg, 1998, 187(3): 255262.
3. 張圣道, 雷若慶. 暴發(fā)性急性胰腺炎的初步認(rèn)識 [J]. 中華肝膽外科雜志, 2003, 9(8): 457458..
4. 中華醫(yī)學(xué)會(huì)外科學(xué)分會(huì)胰腺外科學(xué)組. 重癥胰腺炎診治指南 [J]. 中華外科雜志, 2007, 45(11): 727729.
5. 毛恩強(qiáng). 重癥急性胰腺炎急性反應(yīng)期腹腔高壓的識別與處理 [J]. 中國實(shí)用外科雜志, 2006, 26(5): 331333..
6. Mao EQ, Tang YQ, Zhang SD. Formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis [J]. World J Gastroenterol, 2003, 9(11): 26222626.
7. Beal AL, Cerra FB. Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction [J]. JAMA, 1994, 271(3): 226233.
8. Isenmann R, Rau B, Zoellner U, et al. Management of patients with extended pancreatic necrosis [J]. Pancreatology, 2001, 1(1): 6368.
9. 孫家邦. 重癥急性胰腺炎當(dāng)前診治應(yīng)注意的問題 [J]. 中華肝膽外科雜志, 2005, 11(5): 289292.
10. 鄭守華, 張水軍. 急性胰腺炎臨床實(shí)驗(yàn)評價(jià) [J]. 國際外科學(xué)雜志, 2006, 33(6): 459464.
11. Loi P, De Backer D, Vincent JL. Abdominal compartment syndrome [J]. Acta Chir Belg, 2001, 101(2): 5964.
12. Schein M, Wittmann DH, Aprahamian CC, et al. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intraabdominal pressure [J]. J Am Coll Surg, 1995, 180(6): 745753.
13. 毛恩強(qiáng), 湯耀卿, 張圣道, 等. 短時(shí)血液濾過治療重癥胰腺炎的機(jī)制探討 [J]. 中華外科雜志, 1999, 37(3): 141143.
  1. 1. Isenmann R, Rau B, Beger HG. Early severe acute pancreatitis: characteristics of a new subgroup [J]. Pancreas, 2001, 22(3): 274278.
  2. 2. Bosscha K, Hulstaert PF, Hennipman A, et al. Fulminant acute pancreatitis and infected necrosis: results of open management of the abdomen and “planned” reoperations [J]. J Am Coll Surg, 1998, 187(3): 255262.
  3. 3. 張圣道, 雷若慶. 暴發(fā)性急性胰腺炎的初步認(rèn)識 [J]. 中華肝膽外科雜志, 2003, 9(8): 457458..
  4. 4. 中華醫(yī)學(xué)會(huì)外科學(xué)分會(huì)胰腺外科學(xué)組. 重癥胰腺炎診治指南 [J]. 中華外科雜志, 2007, 45(11): 727729.
  5. 5. 毛恩強(qiáng). 重癥急性胰腺炎急性反應(yīng)期腹腔高壓的識別與處理 [J]. 中國實(shí)用外科雜志, 2006, 26(5): 331333..
  6. 6. Mao EQ, Tang YQ, Zhang SD. Formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis [J]. World J Gastroenterol, 2003, 9(11): 26222626.
  7. 7. Beal AL, Cerra FB. Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction [J]. JAMA, 1994, 271(3): 226233.
  8. 8. Isenmann R, Rau B, Zoellner U, et al. Management of patients with extended pancreatic necrosis [J]. Pancreatology, 2001, 1(1): 6368.
  9. 9. 孫家邦. 重癥急性胰腺炎當(dāng)前診治應(yīng)注意的問題 [J]. 中華肝膽外科雜志, 2005, 11(5): 289292.
  10. 10. 鄭守華, 張水軍. 急性胰腺炎臨床實(shí)驗(yàn)評價(jià) [J]. 國際外科學(xué)雜志, 2006, 33(6): 459464.
  11. 11. Loi P, De Backer D, Vincent JL. Abdominal compartment syndrome [J]. Acta Chir Belg, 2001, 101(2): 5964.
  12. 12. Schein M, Wittmann DH, Aprahamian CC, et al. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intraabdominal pressure [J]. J Am Coll Surg, 1995, 180(6): 745753.
  13. 13. 毛恩強(qiáng), 湯耀卿, 張圣道, 等. 短時(shí)血液濾過治療重癥胰腺炎的機(jī)制探討 [J]. 中華外科雜志, 1999, 37(3): 141143.