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目的探讨高脂血症性重症急性胰腺炎(HL-SAP)综合治疗的原则与措施。方法回顾性分析1996年1月至2000年12月和2001年1月至2006年8月两阶段收治的54例 HL-SAP 患者的临床资料。第一阶段(25例)患者采用常规降脂治疗或附加手术治疗;第二阶段(29例)患者采用多途径非手术综合治疗或附加以微创为主体的手术治疗。结果 54例 HL-SAP 患者,非手术治疗33例(61.1%),手术治疗21例(38.9%),总病死率18.5%(10/54)。第一阶段患者的非手术治疗病死率21.4%(3/14),手术治疗病死率36.4%(4/11)。第二阶段患者的非手术治疗病死率10.5%(2/19),手术治疗病死率10%(1/10)。第二阶段患者在治愈率、总并发症发生率、病死率、第4天甘油三酯及慢性健康状况评分Ⅱ和平均住院时间方面与第一阶段相比均有明显改善(P<0.05)。结论 HL-SAP 治疗应在遵循个体化治疗方案的前提下,充分重视多途径的非手术综合治疗措施,正确把握HL-SAP 的外科干预时机与指征,术式的选择亦应遵循微创化原则,同时出院后密切监测并控制血脂。
Objective To investigate the principles and measures of comprehensive treatment of hyperlipidemic severe acute pancreatitis (HL-SAP). Methods The clinical data of 54 patients with HL-SAP admitted from January 1996 to December 2000 and from January 2001 to August 2006 were retrospectively analyzed. In the first stage (25 cases), patients were treated with conventional lipid-lowering therapy or additional surgery. In the second stage (29 cases), multi-path non-surgical treatment or additional minimally invasive surgery was used. Results Of 54 patients with HL-SAP, 33 (61.1%) had nonoperative treatment and 21 (38.9%) had surgical treatment. The overall mortality rate was 18.5% (10/54). The non-surgical treatment of patients in the first phase of mortality was 21.4% (3/14), surgical treatment of mortality was 36.4% (4/11). The second phase of non-surgical treatment of patients was 10.5% (2/19), surgical treatment of mortality was 10% (1/10). Patients in the second stage showed a significant improvement (P <0.05) in the cure rate, the overall complication rate, the mortality rate, the triglyceride and the chronic health status score Ⅱ and the average length of stay in the fourth day. Conclusion HL-SAP treatment should follow the individualized treatment plan under the premise of full attention to multi-channel non-surgical comprehensive treatment measures to correctly grasp the HL-SAP surgical intervention timing and indications, surgical procedures should follow the minimally invasive Principle, while closely monitor and control blood lipids after discharge.