影响重症急性胰腺炎预后的主要因素

目的 :探索重症急性胰腺炎分度和治疗方案对预后的影响。方法 :回顾性分析 1983年— 1998年间176例重症急性胰腺炎患者临床资料 ,根据胰腺出血坏死程度、腹水量及胰外受侵范围 ,将重症急性胰腺炎分为 4度 ,分析各度治愈率和采用不同方案的治疗效果。结果 : 度治愈率为 10 0 % , 度 69.3 % , 度 5 3 .1% , 度2 7.3 %。除 度、 度间差异不明显 ( P>0 .0 5 )外 ,其余各度之间均有明显差异 ( P<0 .0 5 )。 度中切除术组疗效明显差 ( P<0 .0 5 )。结论 :影响预后的主要因素 :1胰腺坏死程度 ,坏死越重 ,预后越差。 2治疗方法的选择 ,治愈率以切除组最差 ( 2 8.6% ) ,清除术组 68.4 % ,非手术组 82 .4 % ,因而 ,保守治疗列为首选治疗方案

CHIEF FACTORS AFFECTING THE PROGNOSIS OF SEVERE ACUTE PANCREATITIS

Objective:To study the effect of clinical condition graduation and treating regimen on the prognosis of severe acute pancreatitis (SAP).Methods:In the period of 1983 to 1998,176 patients with SAP proved by operative findings or CT scanning system were treated.According to necrotizing range and extent,volume of ascites,and range of extrapancreatic spread,the seriousness of SAP was differentiated as four degrees,whose survival rates were analysed.The effect of different degrees and treating regimen on therapeutic results was analysed as well. Results:The survival rate was 100%,69.2%,53.1%,and 27.3% for the four degress respectively.Except for no difference between the second and third degrees (P>0 05),there were distinguishable differences between any other two degrees (P<0 05).No distinguishable difference existed among the three therapeutic groups (excision,clearance,and nonoperation) in their first and second degrees.Subtotal pancreatectomy made a lower survival rate in the third degrees.Conclusion:The chief factors affecting the prognosis of SAP are ①Pancreatic necrotizing degree;the higher the severe degree,the worse the prognosis.②Method optimization.The cure rate of pancreatectomy is 28.6%;that of clearance is 68.4%;that of nonoperation 82.4%.Conservative treatnient should be selected as first chosen.