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目前,对急性间质性胰腺炎的早期治疗,内科和外科医师均同意非手术疗法.但对出血性坏死性胰腺炎的手术效果、手术时间以及手术方法仍有争论.本文简要综述近年来关于急性胰腺炎手术治疗的某些方面.Beger等报告114例出血性坏死胰腺炎的手术结果,随访观察5.5年以上.该组胰腺炎的病因为由乙醇引起者占58%,胆道疾病占17%,特发性占20%.经手术治疗者的病情均很危重,其中39%有胰腺或胰腺周围感染,其死亡率(37.8%)高于无细菌感染者(8.7%).这和Gerzot等在CT引导下对42例病人作经皮细针抽吸进行细菌培养的非手术方法的结果一致.西德报道45例病人的资料表明,疾病第一周5例(11%)证明有感染,在第二周8例(17.8%)有感染.因此,胰腺感染性坏死可在疾病的相对早期发生,对这样的患者尽快作手术引流可能是有利的.当感染存在时,87%病例可能仅是单一病原菌感染,大肠杆菌和肠产气杆菌最为常见.本组患者中,仅约11%患者是厌氧菌
At present, the early treatment of acute interstitial pancreatitis, both medical and surgical physicians agree non-surgical treatment.But the surgical treatment of hemorrhagic necrotizing pancreatitis, operation time and surgical methods are still controversial.This article briefly reviews the recent Beger et al reported 114 cases of hemorrhagic necrotizing pancreatitis operation results, followed up for more than 5.5 years.The cause of this group of pancreatitis caused by ethanol accounted for 58%, biliary disease accounted for 17% , And idiopathic 20%. Surgical patients were critically ill with 39% having pancreas or pancreas infection with a higher mortality rate (37.8%) than those without bacterial infection (8.7%). This is consistent with Gerzot et al. The results of a non-surgical approach to bacterial culture of 42 patients with percutaneous fine needle aspiration under CT guidance were consistent: Western Germany reported data from 45 patients that showed infection in 5 (11%) of the first week of disease, In the second week, 8 (17.8%) had an infection and, as a result, pancreatic necrotic necrosis can occur at a relatively early stage of the disease and it may be advantageous to drain such a patient as soon as possible.When an infection is present, 87% of cases may only have Is a single pathogen infection, Escherichia coli and intestinal production Coli is most common in this group of patients, only about 11% of patients are anaerobes