摘要
目的 介绍重症急性胰腺炎 (SAP)的最近治疗动态。方法 复习相关文献 ,并作综述性报道。结果 SAP急性反应期以维持血液动力学稳定 ,抑制细胞因子过度表达和胰腺分泌 ,预防性使用抗生素 ,完全胃肠外营养 ,维持胰外受损器官的功能等非手术治疗为重点 ,手术时间尽可能延迟 ,这样可提高治愈率 ,减少并发症及再次手术。但对胆源性SAP ,胰腺坏死感染 ,支持治疗无效及诊断不明的病例应早期手术。手术方式应该简单易行 ,确保充分引流及解除胆道梗阻。全身感染期治疗除使用抗生素和胃肠内营养外 ,手术是主要的治疗方法 ,对胰腺坏死感染的治疗以坏死病灶切除和持续性封闭式灌洗为优 ,而胰腺脓肿则行外引流。残余感染期治疗重点是腹腔内残腔的彻底敞开引流。结论 在“个体化方案”指导下 ,按病因、病期进行综合治疗 。
Objective To introduce the current status of treatment of severe acute pancreatitis (SAP). Methods This summarization paper of SAP was made on literature review. Results During the stage of acute reaction , therapy should be emphasized on non surgical management, such as maintaining the homodynamics ; inhibiting the overexpress of cytokines and pancreatic secretion; administering antibiotics preventively, TPN and improving the function of other damaged organs.The operation timing should be delayed if possible.Thus it could increas the cure rate, decrease complications and the possibility of reopeneration. But in the case of SAP with biliary obstruction, secondary infection with necrosis of pancreas; failure to respond to initial intensive treatment and clinical diagnostic was uncertain, early surgery should be performed. The operation should be easy to be done, ensuring enough drainage, and resolving the obstruction of biliary tract. During the septic stage, besides administerded antibiotics and EN, surgery is primary therapeutic method: necrosectomy and continuous closed lavage were considered as a better treatment of infected necrosis focus, while pancreatic absecess should be drained operatively. During the last stage of residual infection, abdominal abscesses should be drained thoroughly. Conculsions According to the etiology and stage of SAP, comprehesive management guided by 'individualized plan'is probably a better strategy of treatment of SAP.
出处
《中国普通外科杂志》
CAS
CSCD
2001年第4期359-361,共3页
China Journal of General Surgery
关键词
胰腺炎
治疗
急性病
综述文献
PANCREATITIS/ther
ACUTE DISEASE
REVIEW LITERATURE
