【摘要】目的 探讨暴发性急性胰腺炎（FAP）的诊治方法。方法 回顾性分析1999年3月至2004年5月我院收治的79例重症急性胰腺炎（SAP）患者的临床资料。结果 79例SAP患者中, FAP患者17例，其中3 d内手术的4例均治愈 ，延期手术4例与非手术治疗的9例均死亡。 结论 主要根据SAP患者的临床表现、动态B超检查或APACHE Ⅱ评分短期大幅增高即可诊断FAP。 一旦确诊，应当机立断，力争手术治疗。 血液滤过或使用大剂量激素可能为呼吸、循环不稳定的患者创造手术时机 。手术方式宜尽量简单有效，开腹手术和经腹腔镜辅助下的腹腔灌洗术引流效果较好，局麻下下腹切口减压引流效果差。手术前后应加强器官功能的监护和支持。
自1996年以来从网上收集国内、外有关暴发性胰腺炎(fulminant acute pancreatitis, FAP)有53篇，其中有9篇为动物（狗3，猪4，鼠2）实验，8篇为器官移植后所发生的，从临床诊断为FAP的只有36篇，且多为个案报告，有5篇报告有3～5例，还有为骤死者4例，这究竟属不属FAP范畴内，难以肯定。因为至今文献中仍没有比较准确的概念或分型。然而各地医院均有遇到类似症状的FAP，治疗困难，来势凶猛，病情险恶，死亡率高。
ObjectiveTo explore protective strategies for organ function of fulminant acute pancreatitis (FAP) in early stage. MethodsThe clinical data of 37 patients with FAP admitted to this hospital within 72 h after onset of symptoms between January 2000 and September 2010 were analyzed retrospectively. FAP was defined as presence of multiple organ dysfunction syndrome (MODS) within 72 h after onset of symptoms. A total of 37 patients with a confirmed diagnosis of FAP were divided into two groups based on whether adopting the protective strategies for organ function in early stage or not. Patients treated between January 2000 and May 2004 did not adopt the protective strategies for organ function (Named nonprotection group, n=21); The other patients treated between June 2004 and September 2010 adopted protective strategies for organ function (Named protection group, n=16). With the exception of the protecting strategies for organ function, the patients with severe acute pancreatitisin received standard treatment in two groups. The acute physiology and chronic health evaluation (APACHE) Ⅱ score and multiple organ dysfunction score (Marshall), rate of pancreas infection, and case fatality were compared between two groups. ResultsCompared with the nonprotection group on day 3 after admission, APACHEⅡ score and Marshall score decreased in the protection group (APACHEⅡ score : 15.71±2.95 versus 17.72±3.77, P=0.137; Marshall score: 6.93±2.73 versus 8.06±2.36, P=0.206, respectively). In addition, the case fatality on day 7 and in hospital case fatality in the protection group decreased as compared with the nonprotection group (case fatality on day 7: 18.75% versus 33.33%, P=0.461; in hospital case fatality: 43.75% versus 57.14%, P=0.515, respectively). There was no significant difference of the rate of pancreas infection between two groups (P=1.000). ConclusionsIt from a case of a particular disease perspective, though the difference is not significant, but the observed improvement in prognosis is attributed by protective strategies for organ function of FAP in early stage to a certain degree, however it is verified by needing to more cases.
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。