【作者】 吴林；

【导师】 帕尔哈提；

【作者基本信息】 新疆医科大学 ， 急诊医学， 2010， 硕士

【摘要】 目的:探讨重症急性胆源性胰腺炎(SABP)手术时机对预后的影响,并分析其死亡的高危因素。方法:对78例SABP患者的临床资料进行回顾性分析,根据手术时间,分为早期手术(2周内)和延期手术(2周后);并根据胆道有无梗阻将患者分为非梗阻型和梗阻型,对两组患者在不同手术时间的治愈率、并发症的发生率及病死率进行比较分析,并对死亡的高危因素采用Logistic回归分析。结果:非梗阻型:早期手术治疗12例,治愈7例,并发症9例,死亡5例;延期手术42例,治愈38例,并发症9例,死亡4例。梗阻型:早期手术治疗10例,治愈7例,并发症6例,死亡3例;延期手术14例,治愈12例,并发症7例,死亡2例。经统计学分析,重症非梗阻型早期与延期手术的治愈率、并发症的发生率、病死率差异有统计学意义( P < 0. 05)。多因素分析显示MODS(OR=15.35 P<0.05),APACHEⅡ评分(OR=2.41 P<0.05)是影响SABP预后的独立危险因素。结论:重症急性胆源性胰腺炎的手术时机应依据个体病情而定,非梗阻型SABP早期手术风险较高,适宜非手术治疗。选择合理的手术时机并对高危因素进行早期预防和及时处理是降低SABP病死率的关键。更多还原

【Abstract】 Objective: To investigate the affecting of the operation opportunity of severe acute biliary pancreatitis (SABP) about prognosis and to study the risk factor affecting the mortality of this and to reduce postoperative mortality. Methods: The clinical data of 78 patients with SABP admitted to the department of surgery of our hospital were retrospectively analyzed. The operation opportunity, the cure rate, the relapse rate, the mortality rate and the risk factoring the mortality were analyzed in 78 patients with the SABP . Results: Based on the analysis of the treatment methods and its outcome , SABP should be divided into two types according to the duct obstruction and the timing of surgical .(1) There are 12 patients of non-obstructive mild type SABP received surgical operations with in 2 weeks after the onset, 7 cases were cured, 9 cases had complications, 5 cases died; of 42 patients received surgical operations after 2 weeks from onset, 38 cases were cured, 9 cases had complications, 4 cases died; (2) There are 10 patients of obstructive mild type SABP received surgical operations with in 2 weeks after the onset, 7 cases were cured, 6 cases had complications, 3 cases died; of 14 patients received surgical operations after 2 weeks from onset, 12 cases were cured, 7 cases had complications, 2 cases died. the incidence of complications and mortality had significantly difference in different operation opportunity of non- obstructive group. Multiple factor Logistic regression analysis indicated that the MODS(OR=15.35, P<0.05), APACHEⅡscore (OR=2.41, P<0.05) were the independent risk factor affecting the prognosis of SABP. Conclusion: The principle of individual operation is importance of SABP. The operation opportunity is one of the most important factors impact the mortality of SABP . The non-obstructive type patients should be cure of better in conservative way. Therefore, to make sure a reasonable operation opportunity and early prevention and correct management on the risk factors play critical roles in reducing the mortality of SABP.更多还原