Surgical Treatment for Fulminant Acute Pancreatitis (Report of 18 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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潘耀振 , 孙诚谊

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暴发性胰腺炎; 治疗

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目的总结暴发性胰腺炎（FAP）的临床特点及诊治经验。方法对2008年5月至2010年7月期间我院收治的18例FAP患者的临床特点及治疗进行回顾性分析。结果18例患者中，2例胆源性FAP患者急诊行胆总管切开减压加T管引流术，术后痊愈1例，死亡1例； 5例发生腹腔间隔室综合征者选择急诊手术行胰腺被膜切开减压加引流术，治愈3例，死亡2例；其余11例患者通过呼吸支持、腹腔灌洗等治疗，其中1例高龄患者既往有冠心病因心功能衰竭而死亡，5例胰腺坏死感染，采取胰腺周围坏死组织清除加引流手术，并根据细菌及真菌培养结果联合使用抗细菌及真菌药物治疗，3例治愈，2例感染未能控制引发多器官功能障碍综合征而死亡。本组共死亡6例。结论FAP的治疗与一般的重症急性胰腺炎相比，有其专有的特点，更注重整体一体化治疗，要求外科医生和ICU医生协同，保护好患者的脏器功能，在全程监护的条件下给予呼吸循环支持，同时第一时间针对患者的病情采取血液滤过、腹腔灌洗、微创手术等治疗。

Citation： 潘耀振,孙诚谊. Surgical Treatment for Fulminant Acute Pancreatitis (Report of 18 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(3): 255-257. doi: Copy

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7.	Beal AL, Cerra FB. Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction [J]. JAMA, 1994, 271(3): 226233.
8.	Isenmann R, Rau B, Zoellner U, et al. Management of patients with extended pancreatic necrosis [J]. Pancreatology, 2001, 1(1): 6368.
9.	孙家邦. 重症急性胰腺炎当前诊治应注意的问题 [J]. 中华肝胆外科杂志, 2005, 11(5): 289292.
10.	郑守华, 张水军. 急性胰腺炎临床实验评价 [J]. 国际外科学杂志, 2006, 33(6): 459464.
11.	Loi P, De Backer D, Vincent JL. Abdominal compartment syndrome [J]. Acta Chir Belg, 2001, 101(2): 5964.
12.	Schein M, Wittmann DH, Aprahamian CC, et al. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intraabdominal pressure [J]. J Am Coll Surg, 1995, 180(6): 745753.
13.	毛恩强, 汤耀卿, 张圣道, 等. 短时血液滤过治疗重症胰腺炎的机制探讨 [J]. 中华外科杂志， 1999, 37(3): 141143.

1. Isenmann R, Rau B, Beger HG. Early severe acute pancreatitis: characteristics of a new subgroup [J]. Pancreas, 2001, 22(3): 274278.
2. Bosscha K, Hulstaert PF, Hennipman A, et al. Fulminant acute pancreatitis and infected necrosis: results of open management of the abdomen and “planned” reoperations [J]. J Am Coll Surg, 1998, 187(3): 255262.
3. 张圣道, 雷若庆. 暴发性急性胰腺炎的初步认识 [J]. 中华肝胆外科杂志, 2003, 9(8): 457458．.
4. 中华医学会外科学分会胰腺外科学组. 重症胰腺炎诊治指南 [J]. 中华外科杂志, 2007, 45(11): 727729.
5. 毛恩强. 重症急性胰腺炎急性反应期腹腔高压的识别与处理 [J]. 中国实用外科杂志, 2006, 26(5): 331333．.
6. Mao EQ, Tang YQ, Zhang SD. Formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis [J]. World J Gastroenterol, 2003, 9(11): 26222626.
7. Beal AL, Cerra FB. Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction [J]. JAMA, 1994, 271(3): 226233.
8. Isenmann R, Rau B, Zoellner U, et al. Management of patients with extended pancreatic necrosis [J]. Pancreatology, 2001, 1(1): 6368.
9. 孙家邦. 重症急性胰腺炎当前诊治应注意的问题 [J]. 中华肝胆外科杂志, 2005, 11(5): 289292.
10. 郑守华, 张水军. 急性胰腺炎临床实验评价 [J]. 国际外科学杂志, 2006, 33(6): 459464.
11. Loi P, De Backer D, Vincent JL. Abdominal compartment syndrome [J]. Acta Chir Belg, 2001, 101(2): 5964.
12. Schein M, Wittmann DH, Aprahamian CC, et al. The abdominal compartment syndrome: the physiological and clinical consequences of elevated intraabdominal pressure [J]. J Am Coll Surg, 1995, 180(6): 745753.
13. 毛恩强, 汤耀卿, 张圣道, 等. 短时血液滤过治疗重症胰腺炎的机制探讨 [J]. 中华外科杂志， 1999, 37(3): 141143.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Surgical Treatment for Fulminant Acute Pancreatitis (Report of 18 Cases)

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