急性胆源性胰腺炎41例诊治体会..doc

急性胆源性胰腺炎41例诊治体会 王庆华 （景东彝族自治县人民医院 676200） [摘 要] 目的:探讨急性胆源性胰腺炎(ABP)的最佳治疗方案及效果。方法:回顾分析我院收治的41例急性胆源性胰腺炎的临床资料，总结ABP的诊治方式和治疗效果。结果:总病例41例,轻症非梗阻型25例，早期非手术治疗效果良好，其中22例伴慢性胆囊炎病史患者缓解4周后行腹腔镜胆囊切除术治愈，3例因影像检查无明显阳性，胰腺炎治愈后出院，随访无复发；轻症梗阻型5例在非手术治疗缓解4周后行ERCP+EST术；重症非梗阻型2例因伴胆囊颈部结石嵌顿入院24h行急诊手术；重症梗阻型9例，其中7例胆总管直径＞1.0cm者，入院12-24h内急诊行开腹胆道探查和胰腺坏死组织清除术，另2例非手术治疗无效于48h内急诊内镜治疗。41例患者均无严重并发症,治愈出院。结论: 轻型非梗阻型ABP早期非手术治疗多可获得缓解，故早期应尽量保守治疗；轻型梗阻型早期可试行非手术治疗，而重症梗阻型应尽早行手术或内镜解除胆道梗阻。 关键词：急性胆源性胰腺炎; 临床分型; 治疗体会 The experience of diagnosis and treatment about 41 patients with acute biliary pancreatitis [Abstract] Objective: To investigate the best treatment and effection of acute biliary pancreatitis (ABP).Methods: The clinical data collected from 41 cases with acute biliary pancreatitis in our hospital were reviewed , the diagnosis and treatment method were summarized.Results :A total of 41 cases ,in which the cases number of the mild non-obstructive type were 25, non-surgical treatment had a good results in early phase. 22 cases of patients with chronic cholecystitis underwent laparoscopic cholecystectomy 4 weeks later since pancreatitis recovered .3 cases had no significant positive by imaging, and discharged after pancreatitis were cured ,without recurrence by follow-up survey. 5 cases of mild obstructive type accepted non-surgical treatment in early phase,underwent endoscopic retrograde cholangiopancreatography(ERCP)+endoscopic sphincterotomy(EST) 4 weeks later. 2 cases of severe non-obstructive type with gallbladder neck calculi accepted emergeny operation within 24h. 9 cases of severe obstructive type, in which 7 cases with common bile duct diameter 1.0cm underwent emergeny operation to explore by choledochostomy and to remove necrotic tissue of pancreatic within 12-24h, another 2 cases accepted emergency endoscopic treatment within 48h as non-surgical treatment were ineffective.A total of 41 cases had no serious complications.Conclusion: The non-obstructive type of ABP can allevi