关键词：胰腺炎；外科手术
摘 要 目的 探讨重症急性胰腺炎(SAP)手术时机和手术方式。方法 对1986～1998年收治的59例SAP患者手术时机、术式及病死率进行回顾性分析。结果 (1)手术病死率为20.3%，其中66.7%为40～60岁患者。性别及病因分类无差异。1992年以前早期手术为主，病死率26.7%，并发症发生率40.0%；1992年以后延期手术为主，病死率13.8%，并发症发生率24.1%。(2)随手术距发病时间延长，病死率逐渐降低，但差异无显著性(P>0.05)。(3)随胰腺坏死程度增加，手术病死率显著增加(P<0.05)。(4)休克、Ⅲ级胰坏死及多脏器功能衰竭的相关病死率分别为42.9%、40.0%和71.4%(P均<0.05)。(5)术式以胆胰联合手术及单纯胰病灶清除引流为主。结论 SAP手术时机是影响手术病死率的重要因素，应采用延期与个体化相结合的处理原则。术式选择应以简单有效，充分引流，清除病灶，去除病因为基本原则。
Surgical timing and modein patients with severe acute pancreatitis.
Jiang Guoying,Lin Renfang,Zhan Yi,et al.Department of General Surgery,Putian City Hospital,Fujiang,351100.
Abstract Objective To investigate thetiming and mode of surgical management in patients with severe acute pancreatitis (SAP).Methods Thetiming,mode of operation and mortality were reviewed retrospectively in 59 SAP casesundergoing laparotomy in our hospital from 1986 to 1998.Result (1)Theoverall mortality was 20.3% and 66.7% of the mortality falls on the age between 40 to 60years,with no difference in etiology and sex.Before 1992,we suggest early operation andthe mortality and morbidity were 26.7% and 40.0%.After 1992,we suggest delayed surgicaltreatment and the mortality and morbidity were 13.8% and 24.1%.(2)The operative mortalityreduced gradually in patients with longer duration of illness (P>0.05).(3)When thedegree of pancreatic necrosis increased,the mortality also increased significantly (P<0.05).(4)Therelated mortality with shock,third-degree pancreatic necrosis and multiorgen failure were42.9%,40.0% and 71.4%,respectively (P<0.05).(5)The main procedures of surgicalmanagement were debridement and/or drainage,and combined surgical measures.Conclusion Thelaparotomy timing is an important factor influencing mortality.We suggest delayed andselective surgery for SAP.Surgery adopted should be simple,efficient in drainage and debridement.
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